Discussion
cognitive impairment, anxiety, somatic pain, pain, MDD, depression
REMISSION
To our knowledge, this was the first study examining the primary changes in ERPs, improvements and effects of a combination treatment with rTMS and antidepressants on depression, pain and cognitive function in untreated MDD patients with somatic pain. Our findings highlighted that rTMS combined with antidepressants led to rapid symptom improvements in patients suffering from depression and pain.The combined treatment group, which received high-frequency (50 Hz) iTBS stimulation and right 1 Hz low-frequency stimulation, showed greater improvements in pain at 3 weeks than the drug treatment group. Previous studies on pain and depression have shown that rTMS with frequencies greater than 5 Hz can significantly improve depression and pain symptoms in patientsAdditionally, using low-frequency rTMS in the right DLPFC has been shown to increase tolerance to human experimental painOur study also demonstrated that the subscale score of cognitive impairment in the CT group was significantly lower than in the DT group, both at 3 weeks and 6 weeks. MMN and P300 latencies were significantly decreased and P300 amplitude dramatically increased in the CT group compared to the DT group at 6 weeksMore interestingly, the anxiety score and pain relief score showed a significant decrease after 3 weeks. However, there was a significant difference in depression score and ERP evaluation after 6 weeks. These results may indicate that rTMS improves anxiety and pain quickly, but that changes in cognitive function are relatively slow and only have a significant effect at 6 weeks. A multicenter depression study in the United States showed that rTMS can improve depression scores by the second week, and patients' depression scores can significantly improve by the sixth weekAs systematic reviews have reported that active rTMS is significantly more effective than sham rTMS in response and remission rates