Mindfulness is Associated with Less Relapse and Recurrence of Major Depressive Disorder
By John M. de Castro, Ph.D.
“Fall seven times, stand up eight.” – Japanese Proverb
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.
Relapsing into depression 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 to study the factors that lead to relapse and recurrence. 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. So, it makes sense to study the relationship of mindfulness with relapse and recurrence of Major Depressive Disorder.
In today’s Research News article “Factors associated with relapse and recurrence of major depressive disorder in patients starting mindfulness-based cognitive therapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9298927/ ) de Klerk-Sluis and colleagues studied patients who were in remission for Major Depressive Disorder and the factors that predicted relapse and recurrence.
They found that the higher the levels of mindfulness the lower the risk of relapse and recurrence. They also found that the greater the ability of mild emotions to reactivate negative thinking patterns (cognitive reactivity) the greater the likelihood of relapse and recurrence. Finally, they found that rumination was associated with relapse and recurrence in patients who were not taking antidepressant drugs but not in patients on the drugs.
It appears that thought processes have large effects on relapse and recurrence of Major Depressive Disorder. But mindful thinking is helpful in preventing relapse. This suggests that mindfulness training should be recommended for patients in remission from Major Depressive Disorder. Indeed, mindfulness training has been shown to reduce the likelihood of relapse.
“But if you’ve fought depression or know somebody who has, you know that no amount of money can fix it. No amount of fame. No logic. The continuing stigma around suicide and mental illness tells me that not enough people truly understand it. I don’t really blame them—its impossible unless you’ve lived it.”- David Chang
CMCS – Center for Mindfulness and Contemplative Studies
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de Klerk-Sluis JM, Huijbers MJ, Löcke S, Spijker J, Spinhoven P, Speckens AEM, Ruhe HG. Factors associated with relapse and recurrence of major depressive disorder in patients starting mindfulness-based cognitive therapy. Depress Anxiety. 2022 Feb;39(2):113-122. doi: 10.1002/da.23220. Epub 2021 Nov 9. PMID: 34752681; PMCID: PMC9298927.
Mindfulness‐based cognitive therapy (MBCT) is effective for relapse prevention in major depressive disorder (MDD). It reduces cognitive reactivity (CR) and rumination, and enhances self‐compassion and mindfulness. Although rumination and mindfulness after MBCT are associated with relapse, the association of CR, rumination, self‐compassion, and mindfulness with relapse before initiation of MBCT has never been investigated.
Data were drawn from two randomized controlled trials, including a total of 282 remitted MDD participants (≥3 depressive episodes) who had been using maintenance antidepressant medication (mADM) for at least 6 months before baseline. All participants were offered MBCT while either their mADM was maintained or discontinued after MBCT. CR, rumination, self‐compassion, and mindfulness were assessed at baseline by self‐rated questionnaires and were used in Cox proportional hazards regression models to investigate their association with relapse.
CR and mindfulness were associated with relapse, independent of residual symptoms, previous depressive episodes, and mADM‐use. Higher CR and lower mindfulness increased the risk of relapse. Self‐compassion was not associated with relapse. For rumination, a significant interaction with mADM‐use was found. Rumination was associated with relapse in patients who discontinued their mADM, while this effect was absent if patients continued mADM.
These results show that CR, rumination, and mindfulness are associated with relapse in remitted MDD‐patients before initiation of MBCT, independent of residual symptoms and previous depressive episodes. This information could improve decisions in treatment planning in remitted individuals with a history of depression.