Mindfulness-based cognitive therapy (MBCT) is an effective treatment option that can help prevent the reoccurrence of major depression in people who have recurrent depression, according to a study.
The largest meta-analysis so far of MBCT for recurrent depression used anonymised individual patient data from 9 randomized trials of MBCT. It suggests that for the millions of people who experience recurrent depression it provides a treatment choice and an alternative or addition to other approaches such as maintenance anti-depressants.
Major depression is a significant public health problem. Without ongoing treatment, as many as 4 out of 5 people with depression relapse at some point. MBCT is a group-based psychological treatment that helps people change the way they think and feel about their experiences and learn skills that reduce the likelihood of further episodes of depression. This meta-analysis included data from trials that compared MBCT to usual care as well as to other active treatments such as maintenance antidepressants – the current mainstay approach to prevention of depressive relapse.
Across the nine trials, 38% of those who received MBCT had a depressive relapse within 60 weeks’ follow-up, in contrast to 49% of those who did not receive MBCT. Taking the time to relapse into account, people who received MBCT were 31% less likely to relapse during the 60-week follow-up compared with those who did not receive MBCT.
The inclusion of individual patient data made it possible to demonstrate that a person’s age, sex, level of education and the age at which they first became depressed did not significantly influence the effectiveness of MBCT, suggesting that this approach is useful for a broad range of people. Those who experienced more symptoms of depression when they entered treatment tended to show greater benefits from MBCT compared with other treatments. Clinical trials systematically record the occurrence of adverse events and negative outcomes such as death or hospitalisation for any cause. The study found no evidence of adverse events associated with MBCT when delivered by well-trained teachers in a clinical context.
Four of the trials compared MBCT combined with continuation, tapering, or discontinuation of antidepressants to continued maintenance antidepressant treatment alone. Data from these trials showed that those who received MBCT, and in many cases tapered or discontinued antidepressant medication, were 23% less likely to relapse to major depression than those who continued on antidepressants and did not receive MBCT.
Willem Kuyken, professor of clinical psychology at the University of Oxford and director of the Oxford Mindfulness Centre, said the new evidence for MBCT was heartening. "We need to do more research, however, to get recovery rates closer to 100% and to help prevent the first onset of depression, earlier in life,” he said. “These are programmes of work we are pursuing at the University of Oxford and with our collaborators around the world.
“While MBCT is not a panacea, it does clearly offer those with a substantial history of depression a new approach to learning skills to stay well in the long-term. It offers people a safe and empowering treatment choice alongside other mainstay approaches such as cognitive-behavioural therapy and maintenance antidepressants.”
The research was published in JAMA Psychiatry.