Mindfulness Is More Effective When Antidepressant Treatment Continues.

[Argirios Argiriou]

March 15, 2016

Mindfulness Is More Effective When Antidepressant Treatment Continues.

Peter Roy-Byrne, MD reviewing Huijbers MJ et al. Br J Psychiatry 2016 Feb 18.

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

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
EquityValant Medical Solutions
Grant / Research supportNIH-NIDA; NIH-NIMH
Editorial boardsDepression and Anxiety; UpToDate
Leadership positions in professional societiesAnxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (President)
CITATION(S):

Huijbers MJ et al. Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: Randomised controlled non-inferiority trial. Br J Psychiatry 2016 Feb 18; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)