Mindfulness-based cognitive therapy (MBCT) offers an alternative to maintenance antidepressant medication but is not superior, according to research published in The Lancet
on 20 April 2015.
Findings from the two-year study suggest that – in patients with long-term depression – MBCT with support to come off antidepressant therapy (MBCT-TS) offers similar levels of protection from having a major relapse as continuing with medication; it is also “reasonably” cost effective.
“This study, combined with previous studies, provides important evidence that MBCT-TS might confer ongoing protection for patients who would like an alternative to maintenance antidepressant medication,” say the researchers, led by Willem Kuyken, of the department of psychiatry, Warneford Hospital, University of Oxford. “The results further suggest that psychosocial treatments such as MBCT offer added value for patients who need them most (ie, those at highest risk of depressive relapse or recurrence).”
Given the interest in alternatives to drug therapy, the researchers sought to discover whether MBCT was superior to maintenance antidepressant treatment. Their data suggest that relapse rates were similar for both treatment approaches.
The study involved two groups of patients with recurrent major depression, recruited from 95 GP practices in Bristol and Devon. In the first group, 212 patients were gradually taken off their antidepressants and attended eight MBCT group sessions held over consecutive weeks. Four refresher sessions took place every three months in the following year; these patients were also trained to practise MBCT at home. The second group of 212 patients stayed on their antidepressant medication for two years.
The researchers assessed participants regularly during the 24 months for evidence of a major depressive episode. Relapse rates were similar in both groups — 44% in the MBCT group and 47% in the maintenance group (P=0.41).
“Benchmarked against epidemiological data, both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms and quality of life,” the researchers say.
Denise Taylor, immediate past president of the College of Mental Health Pharmacy (CMHP) and a senior lecturer in clinical pharmacy at the University of Bath, says there is increasing evidence for MBCT, “not only in place of antidepressants but also as a synergistic treatment”.
“As a person who has taken antidepressants, they help stabilise your mood and hopefully stop you from getting lower in mood, but they are not a cure-all,” she says.
“People need to re-learn coping skills and resilience to manage their day-to-day problems and the causes of these; this is not something a tablet can do on its own.”
Katherine Delargy, deputy chief pharmacist at Barnet, Enfield and Haringey Mental Health NHS Trust and a member of the CMHP council, says that treatment choices should be informed by shared decision-making and may include a combination approach.
“We appreciate the impact of mindfulness, I practise it myself, but would not wish to see people who choose to use medication to achieve recovery from depression being stigmatised for their choice,” she says. “Some people are unable to access mindfulness-based therapies due to time factors, personality and health beliefs.”
The National Institute for Health and Care Excellence recommends psychological interventions, including cognitive behavioural therapy and other talking therapies, as a first-line option in mild to moderate depression.
 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. DOI: http://dx.doi.org/10.1016/S0140-6736(14)62222-4.