By John M. de Castro, Ph.D.
“People at risk for depression are dealing with a lot of negative thoughts, feelings and beliefs about themselves and this can easily slide into a depressive relapse. MBCT helps them to recognize that’s happening, engage with it in a different way and respond to it with equanimity and compassion.” – Willem Kuyken
Major Depression is the most common mental illness, affecting over 6% of the population. It appears to be the result of a change in the nervous system that can generally only be reached with drugs that alter the affected neurochemical systems. But, depression can be difficult to treat. Of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. In, addition, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. So, it is important to not only treat the disease initially, but also to employ strategies to decrease or prevent relapse.
Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. The combination of drugs along with MBCT has been shown to be quite effective in treating depression and preventing relapse. Since, drugs have troubling side effects and can lose effectiveness over time, it is important to determine if after remission, MBCT can continue to prevent relapse if the drugs are removed. In other words, after MBCT can the drugs be withdrawn.
In today’s Research News article “Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial”
Huijbers and colleagues recruited patients who had had three or more depressive episodes, were being treated with anti-depressive medications for at least six months, and were currently in remission. All patients then received an 8-week Mindfulness Based Cognitive Therapy (MBCT) program. MBCT included meditation, body scan, and mindful movement as well as exercises to bring present-moment awareness to everyday activities. Cognitive therapy included education, monitoring and scheduling of activities, identification of negative automatic thoughts and devising a relapse prevention plan. At the conclusion of treatment patients were randomly assigned to have the drugs withdrawn over five weeks or to continue receiving drugs.
Huijbers and colleagues found that at 15 months after MBCT treatment there was a 25% higher rate of relapse when the drugs were withdrawn compared to when they were maintained. In addition, the amount of time to relapse/recurrence was significantly shorter after discontinuation of the drugs. This suggests that withdrawing the drugs increases the risk of relapse/recurrence for patients in remission from major depression and suggests that the combination of MBCT along with a maintenance dose of drug is superior in preventing relapse.
So, prevent depression relapse better with both mindfulness and drugs.
“Because [mindfulness-based cognitive therapy] is a group treatment which reduces costs and the number of trained staff needed it may be feasible to offer MBCT as a choice to patients in general practice…We therefore have a promising relatively new treatment which is reasonably cost effective and applicable to the large group of patients with recurrent depression.” – Roger Mulder
CMCS – Center for Mindfulness and Contemplative Studies
Study Summary
Marloes J. Huijbers, Philip Spinhoven, Jan Spijker, Henricus G. Ruhé, Digna J. F. van Schaik, Patricia van Oppen, Willem A. Nolen,Johan Ormel, Willem Kuyken, Gert Jan van der Wilt, Marc B. J. Blom, Aart H. Schene, A. Rogier T. Donders, Anne E. M. Speckens. Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial. The British Journal of Psychiatry Feb 2016, DOI: 10.1192/bjp.bp.115.168971
Abstract
Background: Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied.
Aims: To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM.
Method: A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov: NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n = 249), were randomly allocated to either discontinue (n = 128) or continue (n = 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity.
Results: The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity.
Conclusions: Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.