A clinical trial evaluating the efficacy of psychotherapy based on mindfulness to prevent relapses and recurrences of depression.
An English randomized controlled trial of Kuyken and colleagues, published in the Lancet in 2015 compares the efficacy after two years of a mindfulness-based cognitive therapy over antidepressants on relapse prevention and recurrence in people with depression. The results show that this therapy is as effective as antidepressants in preventing depressive relapse and recurrence.
The Study Rationale
50-80% of people with depression have a higher risk of relapse and made of recurrence in their lifetime. A relapse is the appearance of a new depressive episode in a depressed person. A recurrence is the reappearance of a depressive episode after a full recovery from the previous depressive episode. The National Institute for Health and Care Excellence UK (NICE) recommends that people who have already recurrence of major depressive episodes to maintain antidepressant treatment for at least two years. However, the compliance rate is low. Many patients prefer to follow a psychosocial intervention that offers them a better long-term protection against relapses and recurrences. The mindfulness-based cognitive therapy (MBCT-TS) is intended to provide people who have had a recurrence of major depressive primordial knowledge to stay healthy as long as possible. This psychotherapy reduces by 34% the rate of recurrence and relapse compared to current treatments or placebo. This clinical trial will verify by comparing a group enjoying a MBCT-TS to another treated with an antidepressant.
A mindfulness-based cognitive therapy for people with depression proposed would reduce by 34% the risk of recurrence and relapse.
Is a mindfulness-based cognitive therapy is an effective alternative to antidepressants to prevent recurrence and relapse of major depression?
The randomized controlled trial of English Kuyken and colleagues compared a group of patients undergoing mindfulness-based cognitive therapy (MBCT-TS), for which stopping or decreasing the antidepressant was taken advocated , a group receiving antidepressant treatment.
424 participants were recruited at a complete or partial remission of recurrent major depressive disorder according to DSM-IV. The main objective was to assess the number of relapses and recurrences for two years. The secondary objectives were to compare the groups on other measures of effectiveness: the number of days without depression, residual depressive symptoms, psychiatric and medical comorbidities, quality of life and cost-effectiveness.
Participants are measured at six different times: at the start of intervention, 12 weeks, 9, 12, 18, 27 months.
The Non-Pharmacological Intervention (NPI) assessed
The NPI is a method of psychotherapy called mindfulness-based cognitive therapy (MBCT-TS). MBCT-TS is based on a different method of psychotherapy, therapy based on full awareness effective for stress reduction (MBSR Mindfulness also known under the name). Cognitive-behavioral therapy (CBT) have proven effective in preventing relapses and recurrences in acute depression. The mindfulness-based cognitive therapy aims to teach people to become more aware of their bodily sensations, thoughts and feelings associated with relapse and recurrence. Participants are trained in mindfulness and CBT both in group sessions and exercises to perform alone. Group sessions are intended to provide knowledge on depression recurrence to better cope. The program consists of 8 group sessions with one session per week lasting 2:25. The operation lasts eight weeks. 4 sessions of knowledge update are also established every 3 months during the second year.
The study showed no reduction in risk of recurrence and higher relapse with MBCT-TS (44%) compared to the group that maintains its antidepressant (47%) during the 24 month follow-up for the entire test group. However, MBCT-TS further reduced the risk of recurrence and relapse compared to an antidepressant for participants who suffered severe childhood abuse.
The mindfulness-based cognitive therapy (MBCT-TS) improves both the quality of life and depressive symptoms than the antidepressant. It is similar also in the cost-effective and committed social spending.
The study shows an equivalence of mindfulness-based cognitive therapy (44%) and the antidepressant (47%) in preventing recurrence and relapse.
What it means for Patients
The mindfulness-based cognitive therapy (MBCT-TS) is a good alternative to antidepressants at the end of a major depressive episode as it provides the same benefits in preventing recurrence or relapse, and on quality of life.
What it means for Healthcare Professionals
MBCT-TS is an effective non-drug alternative to antidepressants in preventing relapse and recurrence of major depressive episodes. In addition, the psychosocial care has better protection for those most at risk of recurrence and relapse, ie those who have suffered violent abuse during childhood.
What it means for Researchers
The randomized controlled trial was approved by the National Ethics Commission of the National Institute for Health and Care Excellence UK (NICE). The trial was conducted and reported according to the CONSORT recommendations. The rigor of the methodology designed to compare the efficacy of non-drug intervention with a drug is such that the researchers were able to publish their study in one of the best medical and scientific journals in the world, The Lancet. They made the choice to compare the efficacy of a method of psychotherapy an antidepressant. Another possibility would have been to test this method against routine care, a placebo or no drug therapy. Prior reflection on the type of control group is critical in the design of any randomized controlled trial.
What it means for Policymakers
MBCT-TS is a non-drug alternative efficient and cost-effective antidepressants in preventing relapse and recurrence of major depressive episodes. The study higher benefit for people who have suffered violent abuse during childhood.
Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, Lewis G, Watkins E, Brejcha C, Cardy J, Causley A, Cowderoy S, Evans A, Gradinger F, Kaur S, Lanham P, Morant N, Richards J, Shah P, Sutton H, Vicary R, Weaver A, Wilks J, Williams M, Taylor RS, Byford S (2015). 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, 386, 63-73.
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To reference this Blog en Sante © article.
Ninot G (2015). Prevent relapse of depression through mindfulness. Blog en Sante, A48.
© Copyright 2015 Gregory Ninot. All rights reserved.