|
Depression typically has a relapsing and recurrent
course. Without ongoing treatment, individuals with
recurrent depression have a high risk of repeated
depressive relapses or recurrences throughout their
life with rates of relapse or recurrence typically
in the range 50–80%.
Maintenance antidepressants for at least 2 years is
the current recommended treatment, but many
individuals are interested in alternatives to
medication.
Mindfulness-based cognitive therapy , MBCT, (a
combination of group counseling sessions and
meditation exercises) has been shown to reduce risk
of relapse or recurrence compared with usual care,
but has not yet been compared with maintenance
antidepressant treatment in a definitive trial.
Researchers aimed to see whether MBCT with support
to taper or discontinue antidepressant treatment (MBCT-TS)
was superior to maintenance antidepressants for
prevention of depressive relapse or recurrence over
24 months.
In this single-blind, parallel, group randomised
controlled trial (PREVENT), scientists recruited
adult patients with three or more previous major
depressive episodes and on a therapeutic dose of
maintenance antidepressants, from primary care
general practices in urban and rural settings in the
UK.
Participants were randomly assigned to either MBCT-TS
or maintenance antidepressants (in a 1:1 ratio) with
a computer-generated random number sequence with
stratification by centre and symptomatic status.
Participants were aware of treatment allocation and
research assessors were masked to treatment
allocation. The primary outcome was time to relapse
or recurrence of depression, with patients followed
up at five separate intervals during the 24-month
study period. The primary analysis was based on the
principle of intention to treat.
Between March 23, 2010, and Oct 21, 2011,
researchers led by Willem Kuyken, of the University
of Oxford in the U.K., assessed 2188 participants
for eligibility and recruited 424 patients from 95
general practices, aged 18 years and older with at
least three previous episodes of severe depression
and who were currently taking drugs for the
disorder. 212 patients were randomly assigned to
MBCT-TS and 212 to maintenance antidepressants.
Among the 366 participants still in the study after
two years, 94 assigned to the therapy group and 100
of those on antidepressants had experienced a
relapse of their depression, a difference between
groups small enough that it could have been due to
chance.
The time to relapse or recurrence of depression did
not differ between MBCT-TS and maintenance
antidepressants nor did the number of serious
adverse events.
Five adverse events were reported, including two
deaths, in each of the MBCT-TS and maintenance
antidepressants groups. No adverse events were
attributable to the interventions or the trial.
Scientists found no evidence that MBCT-TS is
superior to maintenance antidepressant treatment for
the prevention of depressive relapse in individuals
at risk for depressive relapse or recurrence. Both
treatments were associated with enduring positive
outcomes in terms of relapse or recurrence, residual
depressive symptoms, and quality of life.
See also
Acupuncture as good as counseling for depression:
study (2013-09-26)
For more information
THE LANCET
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
MDN |