Introduction
cognitive impairment, Pain, pain, depressive disorder, cognitive dysfunction, depressive, MDD, depression
CORTEX
Pain is one of the most common symptoms in patients with major depressive disorder (MDD), being present in 65% of casesCognitive impairment is another common and often persistent symptom of MDD. Patients with pain and cognitive impairment are more challenging to treat and have longer treatment durations. Furthermore, cognitive dysfunction may persist even after the patient's depressive symptoms have significantly resolvedRepetitive transcranial magnetic stimulation (rTMS) is a technique involving noninvasive stimulation of the cerebral cortex. Multiple studies involving rTMS in MDD patients with pain have reported that TMS significantly relieves pain in patients with MDDLately, event-related potentials (ERPs) with a temporal resolution of milliseconds have increasingly been used for cognitive function evaluation. The most frequently reported components of the ERP are P300 and mismatch negativity (MMN). The P300 latency reflects the time spent on cognitive processing of the stimulus and the P300 amplitude is related to the quantity of attentional resources allocated during the task and memory performanceHowever, ERP changes after rTMS treatment in patients with MDD and pain remain unknown. To fill this gap in the literature, the current longitudinal study explored the effects of rTMS-combined antidepressant pharmacotherapy on depression, pain, and cognitive function in MDD patients with pain. Sertraline was chosen for drug therapy for its efficacy and good tolerance.We hypothesized that compared with the drug therapy group (DT), the combination therapy (CT) group (drug therapy combined with rTMS) would show more rapid improvements in depression, pain, and cognitive function. In addition, compared with the DT group, the latency or amplitude of ERP was hypothesized to be significantly enhanced in the CT group.