Reduce Treatment-Resistant Depression with Mindfulness
By John M. de Castro, Ph.D.
“MBCT is a major achievement. Based on a coherent body of experimental work, the treatment has proven its worth in reducing the recurrence of depression and, as a consequence, changing the future prospects of numerous people whose lives are blighted by repeated episodes of this disabling condition.“ – David Clark
Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, 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. Even after remission some symptoms of depression may still be present (residual symptoms).
Being depressed and not responding to treatment or relapsing 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 relieve the suffering. Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs fail.
The most commonly used mindfulness technique for the treatment of depression is Mindfulness-Based Cognitive Therapy (MBCT). MBCT was developed specifically to treat depression. It involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. MBCT has been shown to be as effective as antidepressant drugs in relieving the symptoms of depression and preventing depression reoccurrence and relapse. In addition, it appears to be effective as either a supplement to or a replacement for these drugs.
In today’s Research News article “Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175087/ ), Cladder-Micus and colleagues recruited adult patients with current depression who had failed to respond to antidepressant drug treatment. All participants continued with treatment as usual including antidepressant medication, psychological treatment, support by a psychiatric nurse, or day‐hospital treatment. Half of the participants were randomly assigned to receive 8 weeks, 2,5 hour once a week, of group based Mindfulness-Based Cognitive Therapy (MBCT). They were measured before and after treatment and 3 and 6 months later for depressive symptoms, remission, rumination, quality of life, mindfulness, and self-compassion.
They found that the addition of Mindfulness-Based Cognitive Therapy (MBCT) to treatment as usual resulted in decreased depressive symptoms which was significant only for participants who completed the program. There was a 42% remission rate for the MBCT group that was significantly better than the 22% rate in the treatment as usual group. The MBCT group also had significantly improved mindfulness and self-compassion.
These results are impressive and corroborate previous findings that MBCT is an effective treatment for depression and its recurrence and even in the cases where drugs fail. Depressed patients are suffering and if the depression isn’t lifted by drug treatments, the suffering becomes chronic. The fact that MBCT can help these treatment resistant patients, reducing depressive symptoms and producing remissions in greater numbers of patients, should not be underestimated. Since suicide is a real possibility in these patients, MBCT may not only be reducing suffering but actually saving lives,
So, reduce treatment-resistant depression with mindfulness.
“MBCT was developed for people with recurring episodes of depression or unhappiness, to prevent relapse. It has been proven effective in patients with major depressive disorder who have experienced at least three episodes of depression.” – Psychology Today
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Abstract
Cladder-Micus, M. B., Speckens, A., Vrijsen, J. N., T Donders, A. R., Becker, E. S., & Spijker, J. (2018). Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial. Depression and anxiety, 35(10), 914-924.
Background
Chronic and treatment‐resistant depressions pose serious problems in mental health care. Mindfulness‐based cognitive therapy (MBCT) is an effective treatment for remitted and currently depressed patients. It is, however, unknown whether MBCT is effective for chronic, treatment‐resistant depressed patients.
Method
A pragmatic, multicenter, randomized‐controlled trial was conducted comparing treatment‐as‐usual (TAU) with MBCT + TAU in 106 chronically depressed outpatients who previously received pharmacotherapy (≥4 weeks) and psychological treatment (≥10 sessions).
Results
Based on the intention‐to‐treat (ITT) analysis, participants in the MBCT + TAU condition did not have significantly fewer depressive symptoms than those in the TAU condition (–3.23 [–6.99 to 0.54], d = 0.35, P = 0.09) at posttreatment. However, compared to TAU, the MBCT + TAU group reported significantly higher remission rates (χ 2(2) = 4.25, φ = 0.22, P = 0.04), lower levels of rumination (–3.85 [–7.55 to –0.15], d = 0.39, P = 0.04), a higher quality of life (4.42 [0.03–8.81], d = 0.42, P = 0.048), more mindfulness skills (11.25 [6.09–16.40], d = 0.73, P < 0.001), and more self‐compassion (2.91 [1.17–4.65], d = 0.64, P = 0.001). The percentage of non‐completers in the MBCT + TAU condition was relatively high (n = 12, 24.5%). Per‐protocol analyses revealed that those who completed MBCT + TAU had significantly fewer depressive symptoms at posttreatment compared to participants receiving TAU (–4.24 [–8.38 to –0.11], d = 0.45, P = 0.04).
Conclusion
Although the ITT analysis did not reveal a significant reduction in depressive symptoms of MBCT + TAU over TAU, MBCT + TAU seems to have beneficial effects for chronic, treatment‐resistant depressed patients in terms of remission rates, rumination, quality of life, mindfulness skills, and self‐compassion. Additionally, patients who completed MBCT showed significant reductions in depressive symptoms. Reasons for non‐completion should be further investigated.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175087/