For many stroke survivors, physical rehabilitation is just one part of the journey toward recovery. Emotional healing can be equally difficult. Post-stroke depression (PSD) affects an estimated 33% of individuals after a stroke, making it one of the most common and challenging complications of stroke rehabilitation. This form of depression is not simply a reaction to disability. It occurs because a stroke can disrupt the brain networks that regulate mood, motivation, and cognitive function.
Although traditional treatments such as antidepressant medication and talking therapies can help, research shows that these options may not always provide sufficient relief for stroke survivors. Many experience side effects from medication or have difficulty maintaining long-term tablet adherence due to the already heavy burden of prescriptions after a stroke. As a result, there is growing interest in Transcranial Magnetic Stimulation (TMS therapy) as a promising, non-drug-based treatment option.
TMS for depression uses repeated magnetic pulses to stimulate the dorsolateral prefrontal cortex (DLPFC) — a region that plays a central role in emotional regulation, motivation, social connection, and cognitive processing. After a stroke, this area may become underactive or imbalanced, contributing to feelings of hopelessness and reduced drive.
Unlike antidepressants, which must circulate through the entire body and brain, TMS targets the affected circuits directly, supporting the rebuilding of disrupted neural pathways. Clinical studies have shown that TMS can increase healthy brain chemicals such as serotonin, dopamine, and norepinephrine, improve cerebral blood flow, and enhance brain-derived neurotrophic factor (BDNF), which promotes neuron growth and repair.
A 2024 systematic review and network meta-analysis of 12 randomized controlled trials examined repetitive TMS (rTMS) for the treatment of post-stroke depression. This major study included international data from PubMed, Web of Science, Cochrane Library, Embase, CNKI, and several Chinese medical databases up to April 2024. Its findings were clear:
rTMS significantly improved depression symptoms compared with sham treatment
(Standardised Mean Difference: −1.47, 95% CI −1.97 to −0.97)
rTMS also improved independence and daily functioning
(SMD: 0.78, 95% CI 0.52 to 1.04)
Benefits were maintained long after treatment ended
(follow-up SMD: −1.74)
Importantly, the analysis compared multiple stimulation types. The highest-ranking and most effective option was dual-rTMS — stimulating both hemispheres of the brain — followed closely by high-frequency rTMS and theta burst stimulation (iTBS). The best results were seen with 20-minute sessions, five days per week, over a four-week course, directly treating mood-regulating circuits while restoring inter-hemispheric balance disrupted by the stroke.
Earlier research has also supported the benefits of TMS therapy for stroke-related emotional recovery. Studies published in leading neurology and psychiatry journals demonstrate meaningful reductions in depression severity and improved cognitive and neurological recovery when TMS is included as part of rehabilitation — and crucially, with very few adverse effects reported.
Across studies, TMS treatment has shown a strong safety profile for stroke survivors. Reported side effects, when seen at all, are generally mild and temporary — such as brief scalp discomfort or headache that resolves with rest. No long-term complications have been linked to the treatment in PSD patients.
This means that individuals who cannot tolerate or do not respond to medication still have access to a highly effective treatment option.
Clinical experience in TMS depression treatment continues to reinforce the findings seen in research trials. For example, outcome monitoring across Smart TMS clinics demonstrates that:
Nearly half of patients reach full remission from major depression
Over half experience a clinically significant reduction in depressive symptoms
These results are particularly meaningful for stroke survivors who may have struggled for months — or even years — without relief from more traditional interventions.
TMS therapy does not simply reduce symptoms; it supports the recovery of healthy brain function, enabling people to re-engage in meaningful activities, strengthen relationships, and participate more fully in their physical rehabilitation.
Post-stroke depression can feel overwhelming — but it does not have to define your recovery. The most current evidence shows that TMS for depression provides a powerful, well-tolerated treatment option that goes beyond symptom management to address the neurological root of PSD.
By restoring communication in mood-regulating networks within the brain, TMS treatment can help stroke survivors reclaim confidence, motivation, and joy, ultimately improving both mental wellbeing and rehabilitation outcomes.
If you or a loved one is experiencing depression after a stroke, TMS may offer a new chance at emotional recovery — and a better quality of life.
Gao W, et al. Repetitive transcranial magnetic stimulation for post-stroke depression: systematic review and meta-analysis of randomized controlled trials. PMC. 2023. Available at: https://www.ncbi.nlm.nih.gov/articles/PMC10061017/ PMC
[Anonymous authors] Repetitive transcranial magnetic stimulation for treating post-stroke depression: network meta-analysis of randomized controlled trials. BMC Psychiatry. 2025. Available at: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-07151-1 BioMed Central
Hsu C-Y, et al. Efficacy of repetitive transcranial magnetic stimulation for post-stroke depression: meta-analysis. PMC. 2021. Available at: https://www.ncbi.nlm.nih.gov/articles/PMC7812912/ PMC
Li W, et al. Repetitive transcranial magnetic stimulation for post-stroke depression: meta-analysis of randomized controlled trials. PubMed. 2021. Available at: https://pubmed.ncbi.nlm.nih.gov/33470386/ PubMed
Deng L, et al. Interventions for management of post-stroke depression: a Bayesian network meta-analysis of 23 randomized controlled trials. Scientific Reports. 2017. Available at: https://www.nature.com/articles/s41598-017-16663-0