TWO POINTS CLOSER TO HOPE: REDUCING SUICIDALITY IN MDD WITH DEEP TMS

Background: Standard TMS treatment for MDD is commonly delivered as five sessions/week for 6-9 weeks.We used data from a large TMS registry to determine if deviations to this schedule (longer treatment gaps or lower overall treatment density) negatively impacts treatment effectiveness.Methods: In the NeuroStar Outcomes Registry, 6,443 MDD patients were identified who received 30 sessions within 12 weeks and completed PHQ-9 at baseline and within 4 days of the final session.Patients were classified into 2 groups: (a) No Gap (N=941, 14.6%): 5 treatment days in every 7-day period; (b) Gap (N=5,502, 85.4%): at least one occurrence of < 5 treatment days per week.Treatment effectiveness after 30 sessions measured by PHQ-9 were compared between groups.Length of maximum treatment gap and overall treatment density were examined in relation to magnitude of PHQ-9 change.Results: Average days without treatment (including weekends) per course was 11.4 (No Gaps group) and 17.7 (Gaps group); less than 15% of the entire sample had gaps greater than 5 consecutive days.There was no difference in PHQ-9 response rate between groups (52% and 53%, respectively).Neither overall treatment density nor duration of treatment gap (up to 13 consecutive days) were correlated with PHQ-9 %Change (r=0.015 and r=0.0005, respectively).Conclusions: Large (>5 day) gaps in the treatment were rare.Missing TMS treatments for up to 13 days or having multiple treatment gaps during a course of TMS did not appear to change treatment effectiveness.