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Effectiveness of Mindfulness-based cognitive therapy compared with maintenance antidepressant treatment (2015-05-04)

Depression typically has a relapsing and recurrent course. Without ongoing treatment, individuals with recurrent depression have a high risk of repeated depressive relapses or recurrences throughout their life with rates of relapse or recurrence typically in the range 5080%.
Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication.

Mindfulness-based cognitive therapy , MBCT, (a combination of group counseling sessions and meditation exercises) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial.
Researchers aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months.

In this single-blind, parallel, group randomised controlled trial (PREVENT), scientists recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK.
Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status.
Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat.

Between March 23, 2010, and Oct 21, 2011, researchers led by Willem Kuyken, of the University of Oxford in the U.K., assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices, aged 18 years and older with at least three previous episodes of severe depression and who were currently taking drugs for the disorder. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants.

Among the 366 participants still in the study after two years, 94 assigned to the therapy group and 100 of those on antidepressants had experienced a relapse of their depression, a difference between groups small enough that it could have been due to chance.
The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants nor did the number of serious adverse events.
Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial.

Scientists found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life.

See also
Acupuncture as good as counseling for depression: study (2013-09-26)

For more information
THE LANCET
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

MDN