MINDFULNESS-BASED COGNITIVE THERAPY AND ANTIDEPRESSANTS
Kuyken W, Hayes R, Barrett B, et al. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet. 2015;386(9988):63-73. doi:10.1016/S0140-6736(14)62222-4.
Mindfulness-based cognitive therapy—a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse—with support to taper or discontinue antidepressant treatment (MBCT-TS) is neither superior nor inferior to maintenance antidepressant treatment for preventing a depressive relapse, according to the PREVENT trial.
Researchers randomly assigned 424 patients to MBCT-TS or maintenance therapy and found no difference in time to relapse or recurrence of depression between the two groups. Rates of adverse effects were similar in both groups.
The study authors note that both treatments were associated with positive outcomes regarding relapse or recurrence, residual depressive symptoms, and quality of life.
COMMENTARY
Patients with recurrent depression have a 50% to 80% lifetime rate of relapse, making a prevention strategy an important part of their care. Current recommendations suggest long-term continuation of antidepressant treatment decreases recurrence by 50% to 60%.1 However, antidepressant medication only works for as long as you take it, and many people do not want to be on antidepressants long term. A previous study compared MBCT-TS, continuation of antidepressant medication, and placebo; the respective relapse rates of 28%, 27%, and 71% indicate that both MBCT-TS and antidepressant medication substantially decrease the rate of depression relapse.2 This study provides further evidence that MBCT-TS is an excellent alternative to antidepressant medication for decreasing depression relapse.
1. Geddes JR, Carney SM, Davies C, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003;361:653-661.
2. Segal ZV, Bieling P, Young T, et al. Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Arch Gen Psych. 2010;67:1256-1264. doi:10.1001/archgenpsychiatry.2010.168.
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