Mindfulness-Based Cognitive Behavioral Therapy Curbs Depression Relapse

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At least 50% of patients who recover from an initial episode of major depressive disorder experience at least 1 subsequent episode.
At least 50% of patients who recover from an initial episode of major depressive disorder experience at least 1 subsequent episode.

A new meta-analysis published in JAMA Psychiatry reports that mindfulness-based cognitive therapy (MBCT) reduced the risk of depressive relapse compared with usual treatment and active treatment groups in 9 randomized controlled trials.1

Major depressive disorder carries the risk of a high rate of recurrence. At least 50% of patients who recover from an initial episode experience 1 or more subsequent episodes, typically within 5 years of onset, according to a previous paper that appeared in Clinical Psychology Review

An estimated 80% of patients who have had 2 episodes experience an additional recurrence, and those with a general history of depression will have 5 to 9 lifetime episodes. Because of the frequency of recurrence, depression is associated with significant adverse effects on personal and public health, including a risk of suicide approximately 20 times that of the general population and serious impairment in occupational and social functioning. Additionally, the direct and indirect costs of the illness were estimated to exceed $16 billion in 1996.

Given the severity of such issues linked with depression and its recurrence, the development of effective relapse prevention approaches is critical. MBCT was designed for patients whose depression is in remission but who continue to be at high risk for recurrence, and it has shown promise in reducing relapse in these patients. The approach “teaches psychological skills that target cognitive mechanisms implicated in depressive relapse… by combining systematic mindfulness training with elements from cognitive therapy,” according to the authors of the new meta-analysis.

Researchers from multiple international universities examined individual data of 1258 patients (IPD; 75% female) from the studies to determine the efficacy of manualized MBCT in relapse prevention for recurrent depression. “Unlike meta-analyses of aggregate data at the trial level, IPD analyses permit the investigation of patient-level characteristics that may be potential moderators of treatment effects,” the authors wrote. While a previous meta-analysis published in 2011 found a 34% relative risk reduction associated with MBCT vs treatment as usual or placebo, the current analysis aimed to explore whether there were differences in efficacy between subgroups of people known to have higher or lower risk for depressive relapse.

Results show that, within a 60-week follow-up period, patients who received MBCT had a reduced risk of relapse vs patients who received usual treatment or other active treatments. The analysis further revealed that variables including age, sex, education, relationship status, age at depressive onset, and number of prior episodes did not moderate the effect, though “there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments,” note the authors. The latter findings are in line with other recent studies in which MBCT was shown to be more effective for patients with fluctuating symptoms and a history of early adverse events.

“The results of this meta-analysis are promising and suggest that MBCT can provide a viable relapse prevention intervention for … a broad range of people with recurrent depression,” the authors said in a statement.

References

  1. Kuyken W, Warren FC, Taylor RS, et al. Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse. JAMA Psychiatry. 2016; Apr 27. [Epub ahead of print] doi:10.1001/jamapsychiatry.2016.0076
  2. Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin Psychol Rev. 2007;27(8):959-985.
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