Mindfulness-based cognitive therapy to prevent relapse in recurrent depression.

TLDR

Mindfulness‑based cognitive therapy (MBCT) offers an additive benefit to usual care for people at risk of depressive relapse. This study compared MBCT with maintenance antidepressant medication (m‑ADM) for relapse prevention, secondary outcomes, and cost‑effectiveness in patients with recurrent depression. A parallel two‑group randomized controlled trial assigned 62 patients to m‑ADM and 61 to MBCT plus support to taper or discontinue antidepressants. Over 15 months, MBCT lowered relapse rates to 47 % versus 60 % with m‑ADM (HR 0.63), reduced residual symptoms, comorbidity, and improved physical and psychological quality of life, incurred similar annual costs, and led 75 % of participants to discontinue antidepressants, suggesting MBCT is a viable alternative for relapse prevention.

Abstract

For people at risk of depressive relapse, mindfulness-based cognitive therapy (MBCT) has an additive benefit to usual care (H. F. Coelho, P. H. Canter, & E. Ernst, 2007). This study asked if, among patients with recurrent depression who are treated with antidepressant medication (ADM), MBCT is comparable to treatment with maintenance ADM (m-ADM) in (a) depressive relapse prevention, (b) key secondary outcomes, and (c) cost effectiveness. The study design was a parallel 2-group randomized controlled trial comparing those on m-ADM (N = 62) with those receiving MBCT plus support to taper/discontinue antidepressants (N = 61). Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04). MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains. There was no difference in average annual cost between the 2 groups. Rates of ADM usage in the MBCT group was significantly reduced, and 46 patients (75%) completely discontinued their ADM. For patients treated with ADM, MBCT may provide an alternative approach for relapse prevention.