Mindfulness Is More Effective When Antidepressant Treatment Continues

Summary and Comment |
March 15, 2016

Mindfulness Is More Effective When Antidepressant Treatment Continues

  1. Peter Roy-Byrne, MD

The combination leads to lower risk for relapse in patients with partially or fully remitted recurrent depression.

  1. Peter Roy-Byrne, MD

Mindfulness-based cognitive therapy (MBCT) is as effective as antidepressants in preventing relapse in patients with recurrent major depression. Researchers in a multisite Netherlands study examined whether MBCT alone was as effective as (i.e., “noninferior to”) MBCT with antidepressants in preventing relapse in 249 patients who were taking antidepressants (selective serotonin reuptake inhibitors, 76%), had ≥3 prior depressive episodes, and were in either full (53%) or partial (47%) remission.

MBCT was provided in eight 2.5-hour weekly group sessions plus one all-day session; gradual antidepressant taper took place over 5 weeks beginning with session 7. Outcomes were assessed quarterly for 15 months.

Relapse rates were 54% for MBCT alone vs. 39% for MBCT plus antidepressants in an intention-to-treat analysis and 69% vs. 46% in the per-protocol analysis. Both comparisons demonstrated that MBCT alone was inferior (i.e., “not noninferior”) to MBCT plus antidepressants. Number of prior depressive episodes, full or partial remission status at baseline, receipt of prior cognitive behavioral therapy, and sex were unrelated to outcome. Differences were evident at the 3-month assessment, shortly after medication taper had been completed.

Comment

These findings in a large, real-world sample are at variance with several studies performed in research settings, where MBCT combined with antidepressant withdrawal was comparable to MBCT plus antidepressants in preventing relapse. In this study, unlike in previous ones using stricter research designs, the MBCT sessions blended patients from the two groups, and so messages about viability of antidepressant discontinuation may have been mixed. But the most important message for clinicians is that mindfulness and medication, while quite different interventions, are not competing modalities but may produce an important synergism in preventive treatment of depression.

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / Research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (President)

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