Zindel Segal of the University of Toronto, lead author of a study published in the Archives of General Psychiatry that found no difference between antidepressant medication and Mindfulness-Based Cognitive Therapy (MBCT) in preventing relapse in depression, spoke with us recently and offered this commentary on the implications of his study.
"With the growing recognition that major depression is a recurrent disorder, patients need treatment options for preventing depression from returning to their lives. Data from the community suggest that many depressed patients discontinue antidepressant medication far too soon, either because of side effect burden, or are unwilling to take medicine for years. All depressed patients in our study were first treated with an antidepressant until their symptoms remitted. They were then randomly assigned to come off their medication and receive MBCT; come off their medication and receive a placebo; or stay on their medication. The novelty here lies in comparing the effectiveness of sequencing pharmacological and psychological treatments versus maintaining the same treatment - antidepressants - over time.
"Mindfulness-based cognitive therapy teaches skills in emotion regulation so that patients can monitor possible relapse triggers as well as adopt lifestyle changes conducive to sustaining mood balance. Clinical assessments were conducted at regular intervals, and over an 18 month period, relapse rates for patients in the MBCT group did not differ from patients receiving antidepressants, with both in the 30% range.
"The real world implications of these findings bear directly on the front line treatment of depression. For that sizable group of patients who are unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse. An additional benefit is that this strategy of sequential intervention — offering pharmacological and psychological interventions — may keep more patients in treatment and thereby reduce the high risk of recurrence that is characteristic of this disorder."