Depression relapse prevention with mindfulness therapy 'on par' with drugs, review shows

People who've recovered from depression stave off relapses with mindfulness therapy as well as with antidepressants, a new review finds.

Mindfulness-based cognitive therapy (MBCT)  is an eight-week group program that helps people become better observers of their own thoughts and emotions and to learn to distance themselves before ruminations spiral downwards.

An international team of psychiatry researchers combined data from nine randomized trials of 1,258 patients total with recurrent depression to compare the mindfulness therapy to placebo, treatment as usual and other active treatments including antidepressants.

People suffering from depression who received the mindfulness therapy were 31 per cent less likely to suffer a relapse during the next 60 weeks compared with those who did not receive it, Willem Kuyken of the University of Oxford, in England and his co-authors reported in a meta-analysis review in Wednesday's issue of the journal JAMA Psychiatry.

"If you compare MBCT against antidepressant medication it basically holds its own, which means it provides protection on par with what people would get from continuing to take to take medications for one, two or three years after they've recovered from depression," said co-author Dr. Zindel Segal, a professor of psychology at the University of Toronto Scarborough.

No one reported side-effects associated with participating in the therapy.

'Access is key'

In his own practice, Segal said the findings from the review give him more confidence to offer the therapy more broadly now that it's been proven effective in older and young people, men and women and people with different socioeconomic  status recovering from depression.

Yet group therapy outside of urban centres In Canada is limited, Segal acknowledged. "Access is key now."

There are books and CD recordings of mindful practices. In the United Kingdom, an online version of the approach, called Be Mindful is about 70 per cent similar to MBCT available in Canada, said Segal.

Most of the researchers were also investigators on the randomized clinical trials. Several, including Segal, receive royalties on books and other training materials. 

Evidence base in 'embryonic stage'

A journal editorial accompanying the review praised its comprehensive analysis but noted questions remain.

"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," wrote said Richard Davidson, of the University of Wisconsin-Madison.

The important question of how mindfulness adds value to cognitive therapy is elusive, Davidson said. It's also not clear which patients respond best, what dose of therapy is needed to prevent relapse and if it could work better when combined with physical exercise. 

For now, what's innovative, Segal said, is using antidepressants first and then MCBT to stay well. 

Antidepressant maintenance works for many people. For some who can't tolerate it, the medication stops working  as well or for women who are pregnant or breastfeeding and looking for an alternative, using MBCT could offer an alternative, Segal said. 

Segal cautioned against stopping antidepressants without discussing it with a physician first, because risk of relapse is so high. That's a separate question that needs to be closely studied.