This article is more than 5 years old. Information may no longer be current.

Researchers find mindfulness-based CBT not superior to antidepressant treatment

Results from a single-blind, parallel, group randomized controlled trial indicate that mindfulness-based cognitive therapy that supports tapering or discontinuing antidepressant treatment had positive outcomes, but was not superior to antidepressant treatment.

“Mindfulness-based cognitive therapy was developed as a psychosocial intervention for teaching people with recurrent depression the skills to stay well in the long term,” study researcher Willem Kuyken, PhD, of the University of Oxford, and colleagues wrote. “Evidence is accumulating that [mindfulness-based cognitive therapy] might confer most benefit to patients at greatest risk, for example those reporting childhood adversity.”

Willem Kuyken

Researchers randomized 424 patients diagnosed with depression to attend an 8-week mindfulness-based cognitive therapy (MBCT) class that supported tapering or discontinuing antidepressant medication (MBCT-TS) or maintenance antidepressant treatment. Patients were aged 18 years or older, had experienced at least three major depressive episodes and were taking a therapeutic dose of maintenance antidepressant drugs. Study participants were followed for 24 months.

“MBCT is a manualized, group-based skills training program designed to enable patients to learn skills that prevent the recurrence of depression,” according to researchers.

Patients randomized to MBCT-TS attended eight group sessions that were 2.25 hours long and led by therapists. Patients randomized to maintenance antidepressant treatment received support from their general practitioners to maintain a therapeutic level of antidepressant medication.

There was no significant difference in risk for relapse or recurrence among patients in the MBCT-TS group vs. patients in the maintenance group (HR = 0.89; 95% CI, 0.67-1.18), according to primary analysis.

At 24 months, adherence had an insignificant effect on reduced risk for relapse or recurrence among patients in the MBCT-TS group compared with patients in the maintenance group (HR = 0.79; 95% CI, 0.58-1.08).

Researchers found a significant association between severity of reported childhood abuse and treatment group. MBCT-TS reduced risk for relapse or recurrence when compared to maintenance antidepressant treatment (47% vs. 59%).

“We noted no evidence for superiority of MBCT-TS compared with maintenance antidepressants for patients with recurrent depression in terms of the primary outcome of time to depressive relapse or recurrence over 24 months,” Kuyken and colleagues wrote. “Cost-effectiveness analysis does no support the hypothesis that MBCT-TS is more cost effective than maintenance antidepressants, in terms of relapse or recurrence or [quality adjusted life years].”

Despite being statistically insignificant, the study findings may suggest that MBCT could be an alternative treatment for some patients with depression, according to Roger Mulder, MB, ChB, PhD, of the University of Otago, Christchurch, New Zealand.

“Kuyken and colleagues’ findings, if benchmarked against the studies of maintenance antidepressant therapy, provide evidence that MBCT might offer a similar ongoing protective effect as that of maintenance antidepressants,” Mulder wrote in an accompanying editorial. “MBCT therefore provides an alternative effective treatment for patients who cannot tolerate or do not wish to have maintenance antidepressant therapy. Because it is a group treatment that reduces costs and the number of trained staff needed, it might be feasible to offer MBCT as a choice to patients in general practice.” – by Amanda Oldt

Disclosure: Kuyken reports acting as co-director of the Mindfulness Network Community Interest Company and teaches on mindfulness-based cognitive therapy nationally and internationally. Mulder reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.