Correo Contemporáneo

psychotherapy:

Mindfulness therapy — in the form known as mindfulness-based cognitive therapy (MBCT)– demonstrates greater efficacy than antidepressant medications for the prevention of a depression relapse, according to new data.

MBCT combines the use of tried-and-true cognitive-behavioral therapy (CBT) techniques with greater focus on self-awareness and self-reflection.

In the current study, the researchers describe how they implemented mindfulness-based therapy: “This is accomplished through daily homework exercises featuring (1) guided (taped) awareness exercises directed at increasing moment-by-moment nonjudgmental awareness of bodily sensations, thoughts, and feelings; (2) accepting difficulties with a stance of self-compassion; and (3) developing an ‘action plan’ composed of strategies for responding to early warning signs of relapse/recurrence.”

Researchers led by Zindel Segal, Ph.D., of the Centre for Addiction and Mental Health in Canada, studied 160 adults who met major depressive disorder criteria and had at least two previous episodes of depression.

After eight months of treatment, 84 — over half — achieved remission from depression. Patients in remission were then randomly assigned to one of three treatment groups: 28 continued taking their medication; 30 had their medication slowly replaced by placebo; and 26 tapered their medication and then received MBCT.

The mindfulness therapy group had the lowest relapse rate at the 18-month followup — 38 percent, compared with 46 percent who were on maintenance antidepressant medication, an 8 percent difference. The placebo group had the worst depression relapse rate of 60 percent.

The researchers further examined and categorized people in the study according to whether they were considered stable or unstable remitters. About half (51 percent) of patients were classified as unstable remitters — individuals who had symptom “flurries” or intermittently higher scores on depression rating scales despite having a low enough average score to qualify for remission. The other half (49 percent) were stable remitters with consistently low scores.

Among unstable remitters, those taking maintenance medication or undergoing cognitive behavioral therapy were about 73 percent less likely to relapse than those taking placebo. Among stable remitters, there were no differences between the three groups.

“Our data highlight the importance of maintaining at least one active long-term treatment in recurrently depressed patients whose remission is unstable,” the authors wrote.

“For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse during an 18-month period.”

It is unclear exactly how mindfulness-based therapy works, but it may change neural pathways to support patterns that lead to recovery instead of to deeper depression, they note.

“Relapse and recurrence after recovery from major depressive disorder are common and debilitating outcomes that carry enormous personal, familial and societal costs,” the authors wrote as background information in the article.

The current standard for preventing relapse is maintenance therapy with a single antidepressant. This regimen is generally effective if patients take their medications, but as many as 40 percent of them do not.

“Alternatives to long-term antidepressant monotherapy, especially those that address mood outcomes in a broader context of well-being, may appeal to patients wary of continued intervention,” the authors said.

The study appears in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.