Mindfulness As Effective As Antidepressants For Preventing Relapse

April 28, 2015

There’s been an increasingly compelling pile of evidence that mindfulness training has effects on both brain and behavior—and its potential for treating depression is among its more promising uses. A new study from the University of Oxford finds that mindfulness-based cognitive therapy (MBCT) is just as effective as antidepressants for preventing a relapse of depression, which affects 50-80% of people who experience a first bout of depression. This may not be entirely surprising, since previous studies have hinted at similar results. But what’s encouraging here is that MBCT may be an effective way to wean people off even successful courses of antidepressants, should they want or need to get off them in the future, without the high risk of relapse.

The team, who published their findings in The Lancet, followed 424 people who were already on antidepressants for major depression. They had them either continue taking the meds for “maintenance” (to prevent relapse) or titrate off while at the same time learning MBCT. The people in the latter group had eight group sessions of MBCT, were given instructions about how to practice on their own, and had four in-person follow-up appointments over the course of a year.

Here’s a little about MBCT: the practice marries mindfulness meditation (or mindfulness training) and cognitive behavior therapy (CBT), which are quite related to begin with. With mindfulness, an individual learns to observe his or her own thoughts with curiosity and without judgment, acknowledge them, and then let them go. Similarly, with CBT, people learn to identify their own negative or destructive thought patterns and replace them, over time, with more productive and positive ones. The two merge naturally and, as MBCT, are thought to be very effective for depression, since intrusive and ruminative thoughts can be some of the central and most crippling symptoms.

And the results from the current study were impressive: MBCT was just as effective as staying on antidepressants over the next two years following treatment: 44% of people in the MBCT group relapsed, while 47% of those in the antidepressant group did.

From their earlier work, the researchers had anticipated that MBCT might actually be more effective than medication in preventing relapse. Although that wasn’t the result of the current study, MBCT was still just as effective as medication, which is good news for those who in principle would like to go off it.

That a meditation-based practice might be as effective as medication for treating depression is not new. In a meta-analysis from Johns Hopkins last year, looking back over many studies on meditation and depression, the effect size for meditation was found to be 0.3, which is largely the same as for antidepressants. This also suggests that meditation might rival medication for actually treating depression – not just preventing relapse, as in the current study. Perhaps not for everyone, but for some.

“Compared to other skills that we train in,” says Madhav Goyal, author of this earlier study, “the amount of training received by the participants in the trials was relatively brief. Yet, we are seeing a small but consistent benefit for symptoms of anxiety, depression, and pain. So you wonder whether we might see larger effects with more training, practice, and skill.”

And that’s the other important finding of the current study: The cost was about the same for both treatments – often a concern with any form of “talk therapy” is that it may be costly more than meds, since multiple visits with trained professionals are required. But this was not the case – perhaps partly because the study used group sessions of MBCT – which gives more fuel to psychosocial treatments being as effective as drug therapies on multiple levels.

The study brings some interesting and hopeful news for those who don’t want to take medication over the long term, or who can’t tolerate the side effects. And, the authors point out, some people just prefer psychosocial treatments over drug treatments for personal reasons. Always speak with your mental health provider before changing or stopping therapies. Since 350 million people worldwide are affected by depression, and it’s one of the leading causes of disability in the world, finding alternative ways to prevent relapse from happening is critically needed. And MBCT, in the right circumstances, might be one of the more effective alternatives.

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