Mindfulness Training Equals Drugs in Effectiveness for Depression
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
Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is distinguishable from everyday sadness or grief by the depth, intensity, and range of symptoms. These can include feelings of sadness, tearfulness, emptiness or hopelessness, worthlessness , angry outbursts, irritability or frustration, even over small matters, loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports, sleep disturbances, tiredness and lack of energy, so even small tasks take extra effort, changes in appetite, anxiety, agitation or restlessness, slowed thinking, suicidal thoughts, and suicide attempts or suicide. Needless to say individuals with depression are miserable.
Depression is generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression. Depression appears to be the result of a change in the nervous system that is primarily treated 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. But, 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. Being depressed and not responding to treatment is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail.
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 “The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study).” See:
or see summary below or view the full text of the study at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781448/ Kuyken and colleagues randomly assigned patients with major depression who are taking antidepressant medications to either continue their medication or taper off the drugs and receive Mindfulness Based Cognitive Therapy (MBCT). Patients were followed for two years. They found that MBCT was as effective as continuing drugs in preventing reoccurrence of the depression, and reducing the number of depression free days, symptoms of depression, quality of life, and other psychological problems. Hence, MBCT was found to be a safe and effective alternative to continued drug treatment.
These results are striking. Mindfulness Based Cognitive Therapy (MBCT) can be used to replace drugs. It is not superior, but it appears to be equal to drug treatments in relieving depression and preventing its reoccurrence. The fact that its benefits were still present two years later indicates that MBCT produces lasting effects. Since MBCT does not have the troubling side effects that typically accompany the drugs, it may be a superior treatment. So, MBCT should be strongly considered to replace antidepressant drugs in the treatment of recurrent major depression
“Mindfulness is a valuable practice for improving the cognitive symptoms of depression, such as distorted thinking and distractibility. It helps individuals recognize these more subtle symptoms, realize that thoughts are not facts and refocus their attention to the present.” –
Margarita Tartakovsky
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., … Byford, S. (2015). The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study). Health Technology Assessment (Winchester, England), 19(73), 1–124. http://doi.org/10.3310/hta19730
Abstract
BACKGROUND: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial.
OBJECTIVES: To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT’s acceptability and mechanism of action.
DESIGN: Single-blind, parallel, individual randomised controlled trial.
SETTING: UK general practices.
PARTICIPANTS: Adult patients with a diagnosis of recurrent depression and who were taking m-ADM.
INTERVENTIONS: Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT’s acceptability and mechanism of action.
MAIN OUTCOMES MEASURES: The primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities.
RESULTS: In total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation.
CONCLUSIONS: There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781448/