In preventing depression relapse, a course of mindfulness-based cognitive therapy using meditation was found to be as effective as traditional antidepressant medication when tested against placebo in a recent study done in Canada.

You can read about the study, carried out at outpatient clinics at the Centre for Addiction and Mental Health (CAMH) in Toronto, and St Joseph’s Healthcare, Hamilton, both in Ontario, Canada, in the December issue of the Archives of General Psychiatry.

First author Dr Zindel Segal, who is Head of the Cognitive Behaviour Therapy Clinic in the Clinical Research Department at CAMH, told the media that:

“With the growing recognition that major depression is a recurrent disorder, patients need treatment options for preventing depression from returning to their lives.”

A particular cause for concern is community-based records suggest that many patients stop taking their antidepressants too soon, either because of the side effects or because they don’t like the idea of being on the drugs for years.

Mindfulness-based cognitive therapy (MBCT) is being increasingly used as a psychotherapeutic approach for stress reduction, pain management, behavior change, and for self-management of symptoms of depression.

MBCT does not use drugs, but teaches patients how to be aware of and to a certain extent regulate emotions so they can spot triggers of relapse early, plus make changes in lifestyle that help them gain a sense of balance in mood and hold the gains for longer.

For this study, Segal and colleagues set out to test how effective the approach might be compared to the current standard of care, which is based on maintenance antidepressant pharmacotherapy.

They recruited 84 patients who met full remission criteria and who had been among160 patients aged 18 to 65 who had been diagnosed with major depressive disorder with a minimum of 2 past episodes, before undergoing 8 months of standard care antidepressant medication.

The 84 patients were then randomly assigned to one of three groups: intervention, standard care, and placebo.

Patients in the intervention group ceased their medication and attended MBCT, patients in the standard care group continued on their medication for another 18 months, and patients in the placebo group also did this, except their active medication was switched to a placebo.

This new type of study allows researchers to compare the effectiveness of swapping from drug treatments to psychological approaches, versus keeping to the drug treatment, over time.

The MBCT comprised 8 weekly group sessions and daily homework. Patients learned how to observe thoughts and emotions, and how to change from ruminating and avoiding thoughts into opportunities to reflect on them without judgement.

This was consolidated through the daily homework where they: practised noticing their moment-to-moment sensations, thoughts and feelings; practised being self-compassionate in accepting difficulties; and made action plans for responding to early warnings of relapse-recurrence triggers.

The objective of the study was to compare rates of relapse in the patients receiving MBCT against the current standard of care based on antidepressant medication.

All participants underwent regular clinical checks and were followed up for about 18 months.

Relapse was defined as ” … a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV,” wrote the authors.

The results of the follow up showed that relapse rates for the MBCT group did not differ from that of the antidepressant (continuing on standard care) group: both were in the 30% range, whereas the relapse rate in the placebo group (the group that did not receive any treatment at all after ceasing their medication) was 70%.

The researchers concluded their finding showed that:

“For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy.”

They also stressed that the finding highlighted how important it was for recurrently depressed patients whose remission is unstable to stay on at least one active long-term treatment.

Segal also added that:

“The real world implications of these findings bear directly on the front line treatment of depression. “

“For that sizeable group of patients who are unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse,” he added, stressing that:

“Sequential intervention– offering pharmacological and psychological interventions– may keep more patients in treatment and thereby reduce the high risk of recurrence that is characteristic of this disorder.”

“Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression.”
Zindel V. Segal; Peter Bieling; Trevor Young; Glenda MacQueen; Robert Cooke; Lawrence Martin; Richard Bloch; Robert D. Levitan.
Arch Gen Psychiatry, Vol. 67 No. 12, pp 1256-1264, December 2010.
DOI: 10.1001/archgenpsychiatry.2010.168

Additional source: Centre for Addiction and Mental Health.

Written by: Catharine Paddock, PhD