Posted 05.18.2015 | by AMRA

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Mindfulness-Based Cognitive Therapy (MBCT) is an eight-week group psychosocial intervention combining mindfulness training with cognitive therapy elements to reduce the risk of relapse and remission in major depressive illness. Prior research demonstrates that MBCT reduces relapse and recurrence in patients with three or more depressive episodes, but MBCT’s efficacy relative to conventional antidepressant therapy has never been tested. This is important because many patients would prefer not to take medication if an effective alternative were available. Kuyken et al. [The Lancet] directly compared MBCT to pharmacotherapy in a randomized, controlled, single-blind clinical trial.

The researchers randomly assigned 424 primarily Caucasian, middle-aged British men and women with a history of three or more major depressive episodes and who were currently receiving maintenance antidepressant therapy to a continued maintenance antidepressant therapy (ADM) condition or a MBCT with support for tapering or discontinuing medication (MBCT-TS) condition. MBCT-TS patients were supported for reducing or stopping their medication in the sixth week of the MBCT protocol. ADM patients were encouraged to continue their medication throughout the two-year study.

Eighty-seven percent of MBCT-TS patients discontinued or tapered their medication, while 76% of the ADM patients continued their medication. Participants were assessed at baseline and five times over 24 months for signs of depressive relapse and recurrence and other illness-related outcomes using clinical interviews and self-report measures.

There was no significant difference in relapse or recurrence between the treatments: 44% of the MBCT-TS group relapsed, and 47% of the ADM group relapsed. Both rates are lower than those typically found for patients with multiple prior depressive episodes. There were also no significant differences between treatments in residual symptoms, depression-free days, medical comorbidity, quality of life, adverse events, or fiscal costs of illness and treatment. MBCT-TS was more effective for patients with a history of childhood physical or sexual abuse, whereas ADM was more effective for patients without abuse histories.

The study shows MBCT to be an effective psychosocial alternative to antidepressant maintenance therapy, especially for patients with adverse childhood histories. This may benefit patients who are distressed by medication side effects and would prefer a non-pharmacological intervention to help them manage their depressive thoughts and emotions.

Reference:

Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., . . . Cardy, J. (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): A randomised controlled trial. The Lancet.

[Link to abstract]