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Mindfulness-based cognitive therapy linked to reduced depressive relapse risk

Mindfulness-based cognitive therapy was associated with a reduced risk of depressive relapse over a 60-week follow-up period compared with usual care and outcomes were comparable to those who received other active treatments, according to an article published online by JAMA Psychiatry.

Recurrent depression causes significant disability. Interventions that prevent depressive relapse could help reduce the burden of this disease. A growing body of research suggests mindfulness-based cognitive therapy (MBCT) is efficacious.

Willem Kuyken, Ph.D., of the University of Oxford, England, and coauthors report the results of analyses of individual patient data from nine published randomized trials of MBCT. The analyses included 1,258 patients with available data on relapse and examined the efficacy of MBCT compared with usual care and other active treatments, including antidepressants.

The authors report MBCT was associated with reduced risk of depressive relapse/recurrence over 60 weeks compared with those who did not receive MBCT. There also appears to be no differing effects for patients based on their sex, age, education or relationship status.

The treatment effect of MBCT on the risk of depressive relapse/recurrence also may be larger in patients with higher levels of depression symptoms at baseline compared with non-MBCT treatments, according to the results. The authors suggest this means that MBCT may be especially helpful to those patients who still have significant depressive symptoms.

The authors acknowledge study limitations related to the availability of the data within the studies.

“We recommend that future trials consider an active control group, use comparable primary and secondary outcomes, use longer follow-ups, report treatment fidelity, collect key background variables (e.g., race/ethnicity and employment), take care to ensure generalizability, conduct cost-effectiveness analyses, put in place ethical and data management procedures that enable data sharing, consider mechanisms of action, and systematically record and report adverse events,” the authors conclude.

Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse, Willem Kuyken PhD, Fiona C. Warren PhD, Rod S. Taylor PhD, Ben Whalley PhD, Catherine Crane PhD, Guido Bondolfi MD, PhD, Rachel Hayes PhD, Marloes Huijbers MSc, Helen Ma PhD, Susanne Schweizer PhD, Zindel Segal PhD, Anne Speckens MD, John D. Teasdale PhD, Kees Van Heeringen PhD, Mark Williams PhD, Sarah Byford PhD, Richard Byng PhD, Tim Dalgleish PhD, JAMA Psychiatry, doi:10.1001/jamapsychiatry.2016.0076, published online 27 April 2016.

Editorial: Mindfulness-Based Cognitive Therapy, Prevention of Depressive Relapse

“Mindfulness practices were not originally developed as therapeutic treatments. They emerged originally in contemplative traditions for the purposes of cultivating well-being and virtue. The questions of whether and how they might be helpful in alleviating symptoms of depression and other related psychopathologies are quite new, and the evidence base is in its embryonic stage. To my knowledge, the article by Kuyken et al is the most comprehensive meta-analysis to date to provide evidence for the effectiveness of MBCT in the prevention of depressive relapse. However, the article also raises many questions, and the limited nature of the extant evidence underscores the critical need for additional research,” writes Richard J. Davidson, Ph.D., of the University of Wisconsin-Madison in a related editorial.

Mindfulness-Based Cognitive Therapy and the Prevention of Depressive Relapse, Richard J. Davidson PhD, JAMA Psychiatry, doi:10.1001/jamapsychiatry.2016.0135, published online 27 April 2016.