To Taper or Not to Taper: That is the Question

Background: Pharmacological treatments routinely end with a taper and tapering final TMS treatments is common. In a large TMS registry, we examined (1) the frequency and nature of tapering TMS for MDD patients, (2) potential associations of taper use with acute phase antidepressant efficacy, and (3) relations of taper use to likelihood and timing of retreatment with TMS due to symptomatic worsening. Methods: In the NeuroStar Outcomes Registry, 7,640 MDD patients were identified with PHQ-9 scores at baseline and ± 4 days of the final session. Patients were classified into three groups: (a) Strict Taper: 1-2 session/wk for the last three weeks (N=938, 12.3%); (b) Loose Taper: received > 2 and < 3 session/wk for the last 3 weeks (N=1,313, 17.2%), and (c) No Taper (N=5,389, 70.5%). Results: Approximately 30% of the sample was tapered. The Taper Group (Strict and Loose) had slightly more severe baseline MDD symptoms, more sessions in the acute course and a lower density of sessions per week. The duration of the acute course was considerably longer with tapering (Avg. 17.3 days). There was no evidence that receiving a taper improved clinical outcomes or prevented or delayed retreatment. Conclusions: This was an open-label, naturalistic study that did not find evidence that the taper is beneficial or protective. Use of a taper was associated with a longer treatment duration. The decision to taper may be based on other factors such as the need to monitor progress. However, tapering does not appear to impact outcomes or durability. Conflicts of Interest: Dr. Sackeim serves as a scientific adviser to and receives consulting fees from Cerebral Therapeutics Inc, Holmusk Inc, LivaNova PLC, MECTA Corporation, Neurolief LTD, Neuronetics Inc, Parow Entheobiosciences LLC and SigmaStim LLC. He receives honoraria and royalties from Elsevier Inc and Oxford University Press. He is the inventor on non-remunerative US patents for Focal Electrically-Administered Seizure Therapy (FEAST), titration in the current domain in ECT, and the adjustment of current in ECT devices, each held by SigmaStim LLC. He is also the originator of magnetic seizure therapy (MST). Dr. Aaronson serves as a scientific adviser to Genomind Inc, LivaNova PLC, Neuronetics Inc, Janssen Pharmaceuticals Inc, and Sage Therapeutics and has received research support from Compass Pathways Inc and Neuronetics Inc. Drs. Hutton, Pages, and West serve as consultants to Neuronetics Inc. Funding: This work was supported by Neuronetics Inc. Disclosures: None