Beliefs about depression, treatment expectations, and interactions with physicians can shape a patient’s choice to use mindfulness-based cognitive therapy (MBCT) along with antidepressant agents to manage recurrent depression, according to study results published in BMJ Open.

Researchers from the United Kingdom performed a qualitative study embedded within the multicenter randomized PREVENT trial. The PREVENT trial compared MBCT (n=212) with antidepressant therapy as maintenance (n=212) for the prevention of relapse and/or recurrence of depression over a 24-month period. Patients from this study were recruited from primary care practices in urban and rural regions in the United Kingdom.

A total of 42 patients who participated in the MBCT arm of the PREVENT trial were sampled to assess different recovery trajectories and experiences. These experiences included treatment response, whether patients reported higher or lower levels of childhood abuse, and the antidepressant discontinuation profile across follow-up. Experiences were documented via patient report during voluntary structured interviews, which took place 2 years following completion of the MBCT intervention.

Thematic analysis revealed 6 overarching themes of patient’s recovery trajectories. First, many patients believed their depression was solely caused by a neurochemical disruption in the brain, and these patients did not understand how an adjunct MBCT psychological intervention could help alleviate symptoms. Some patients reported that they felt confident in discontinuing antidepressants, if only for a short period, once they began understanding and routinely employing the MBCT model. Conversely, many patients found that the MBCT and antidepressant medications could be fused together, rather than using only 1 treatment.


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The second theme was personal agency. Some patients reported that they feared discontinuing their medication yet were hopeful that the MBCT program would work. Despite the hopefulness of these patients, some patients suggested that having more responsibility in managing their disease exerted more pressure to be successful. The third theme, acceptance of depression and recovery, comprised resolving shame, improving attitudes toward self-care, and changing perspectives on mood fluctuations and relapse following MBCT.

Quality of life emerged as the fourth theme. Many patients wanted to experience emotions more fully, particularly positive emotions, but felt hindered by the effects of antidepressant medications. The interviews also uncovered the fifth theme, which included perspectives on antidepressants and tapering-discontinuation — patients reflected on timing and managing withdrawal effects. The role of general practitioners represented the sixth theme, with easy access to the practitioner when discontinuing and following advice emerging as strong sub-themes.

Study limitations included the small sample size, as well as the lack of patients with depression who did not wish to taper/discontinue antidepressants or use a psychological approach for managing their symptoms.

The researchers noted that unrealistic expectations of MBCT, both positive and negative, functioned as a “barrier to engagement.” They also concluded that “strongly held biomedical beliefs appeared to increase feelings of dependency on [antidepressants], and contribute to negative expectations and lack of engagement with psychological therapy.” However, patients with a strongly psychological perspective risked blaming themselves for lack of symptom improvement.

Reference

Tickell A, Byng R, Crane C, et al. Recovery from recurrent depression with mindfulness-based cognitive therapy and antidepressants: a qualitative study with illustrative case studies. BMJ Open. 2020;10(2):e033892.