Lead: On Sept. 4, 2025, clinicians and researchers from institutions including Foothills Hospital in Calgary and U.S. universities described trials testing whether three psychiatric interventions—transcranial magnetic stimulation, antidepressant medication and psychedelics—can enhance recovery after stroke and other brain injuries, with small studies reporting mixed but occasionally encouraging improvements in speech and motor skills.
Key Takeaways
- Clinicians are evaluating TMS, selective antidepressants and psychedelics as potential enhancers of post-injury brain plasticity.
- Dr. Sean Dukelow reported an April 2025 small trial where TMS paired with intensive speech therapy improved fluency in chronic stroke survivors.
- Early evidence for fluoxetine (Prozac) from a 2011 French trial suggested motor gains, but subsequent replications were inconsistent.
- Researchers stress that drug- or device-driven plasticity must be paired with targeted rehabilitation to direct recovery.
- Laboratory work suggests psychedelics can loosen extracellular neuronal scaffolding, reopening windows for learning; human trials testing psilocybin with rehab are underway.
- Larger, controlled trials and careful safety testing remain necessary before routine clinical use.
Verified Facts
For about 15 years Dr. Sean Dukelow has treated stroke patients at Foothills Hospital in Calgary, where traditional neurorehabilitation—repeated practice in physical, occupational and speech therapy—has been the primary evidence-based option to harness the brain’s natural plasticity. Beyond repetitive therapy, currently available adjuncts are largely invasive, such as vagus nerve or spinal cord stimulators.
Transcranial magnetic stimulation, or TMS, uses coils placed outside the scalp to deliver brief magnetic pulses that reach cortical circuits. Dr. Mark George of the Medical University of South Carolina helped pioneer TMS for depression; in April 2025 Dr. Dukelow published a small trial showing that TMS combined with intensive speech therapy improved language fluency months after stroke, and one participant regained two of four lost languages. The study was small and investigators call for larger, targeted trials.
Antidepressant drugs have received attention as potential plasticity enhancers. A 2011 French trial reported that fluoxetine (Prozac) aided motor recovery months after stroke, but subsequent replication attempts returned mixed results. Experts including Dr. Steven Cramer at UCLA note that pharmacologic increases in plasticity are unlikely to help unless linked to directed rehabilitation; several new studies are testing escitalopram (Lexapro) or related drugs paired with intensive therapy beginning months after stroke.
Psychedelic compounds are a third area of interest. In 2023 Dr. Gül Dölen at UC Berkeley published work indicating some psychedelics disrupt the extracellular matrix around neurons, potentially reopening windows for circuit remodeling. Based on this, Dölen and Dr. Steven Zeiler at Johns Hopkins are running safety studies of psilocybin administered alongside intensive physical rehabilitation (including a virtual-reality exercise) for stroke survivors, and they plan larger trials to test whether a reopened learning window months to years after injury can improve motor relearning.
Context & Impact
All three approaches share a conceptual premise: the same brain mechanisms psychiatrists target to alter mood and maladaptive circuits—neural plasticity, growth factors and synaptic remodeling—may also be harnessed to retrain lost skills after structural brain injury. If a validated adjunct could amplify the effects of rehabilitation, it might change long-term outcomes, enabling patients to regain walking, speech or daily independence rather than requiring institutional care.
Clinical impact will depend on several factors:
- Which patients and injury timelines benefit (acute vs. subacute vs. chronic).
- How to safely pair a given intervention with the right type and intensity of therapy.
- Risk profiles, especially for psychedelics in older or medically complex patients.
Regulatory, training and delivery challenges would follow: clinics would need protocols for combined drug/device and therapy programs, payer coverage must be addressed, and robust evidence from phase 3 trials will be required before standard adoption.
“That turbo boost may be the difference between you walking again, talking again, being able to get home,”
Dr. Sean Dukelow, Foothills Hospital
Unconfirmed
- Whether psilocybin can reliably improve motor or language recovery in human stroke survivors remains unproven; current human tests are safety- and feasibility-focused.
- The optimal timing and dosage for combining antidepressants or psychedelics with therapy is not established.
- Long-term safety, especially for older patients with cardiovascular risk, requires further data.
Bottom Line
Transcranial magnetic stimulation, certain antidepressants and psychedelic agents are promising candidates to amplify rehabilitation after stroke, but evidence is preliminary. The most consistent message from researchers is that any biological enhancer must be paired with targeted, intensive training and subjected to larger randomized trials before changing clinical practice.