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Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
Sequence of improvement in depressive symptoms across cognitive therapy and pharmacotherapy
Sunil S Bhar1, Lois A Gelfand, Sabine P Schmid
1Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA. sbhar@mail.med.upenn.edu.au
Background:
The authors examined the patterns of improvement in cognitive and vegetative symptoms of major depression in individuals treated with cognitive therapy (CT) or pharmacotherapy (PT).
Method:
Outpatients diagnosed with major depressive disorder (n=180) were randomized to receive either CT or PT. Cognitive and vegetative symptoms of major depression were measured by the Beck Depression Inventory-II at baseline and regularly throughout 16 weeks of treatment.
Results:
Multivariate hierarchical linear modeling demonstrated the same patterns of change over time for cognitive and vegetative symptoms within CT and within PT.
Limitations:
Self-report measures may not be sufficiently specific to capture subtle differences in improvements between vegetative and cognitive symptoms.
Conclusions:
These results are consistent with Beck's [Beck, A.T., 1984, November. Cognition and theory [Letter to the editor]. Arch. Gen. Psychiatry 41, 1112-1114.] hypothesis that CT and PT have a similar site of action, which when targeted, results in changes in both cognitive and vegetative features.
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