Friday, January 7, 2011


A new study from the Centre for Addiction and Mental Health (CAMH), which is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health, has found that mindfulness-based cognitive therapy - using meditation - provides equivalent protection against depressive relapse as traditional antidepressant medication. 
The study, which was supported by the National Institute of Mental Health, and which was published in the December 2010 issue of Archives of General Psychiatry, compared the effectiveness of pharmacotherapy with mindfulness-based cognitive therapy (MBCT) by studying people who were initially treated with an antidepressant and then, either stopped taking the medication in order to receive MBCT, or continued taking medication for 18 months.
"With the growing recognition that major depression is a recurrent disorder, patients need treatment options for preventing depression from returning to their lives." said Dr Zindel Segal, Head of the Cognitive Behaviour Therapy Clinic in the Clinical Research Department at CAMH.
"Data from the community suggest that many depressed patients discontinue antidepressant medication far too soon, either because of side effect burden, or an unwillingness to take medicine for years.  Mindfulness-based cognitive therapy is a non pharmacological approach that teaches skills in emotion regulation so that patients can monitor possible relapse triggers as well as adopt lifestyle changes conducive to sustaining mood balance.”

The researchers conducted a randomized trial of 166 patients ages 18 to 65 at 2 outpatient clinics in Canada who met criteria for major depressive disorder, and focused on the 84 who achieved remission. These patients were assigned to one of 3 groups: antidepressant maintenance therapy, mindfulness-based cognitive therapy, or placebo.
Study participants who were diagnosed with major depressive disorder were all 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 of this design enabled a comparison to be made as regards the effectiveness of sequencing pharmacological and psychological treatments versus maintaining the same treatment - antidepressants - over time.
Participants in MBCT attended 8 weekly group sessions and practiced mindfulness as part of daily homework assignments. 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 (both in the 30% range), whereas patients receiving placebo relapsed at a significantly higher rate (70%). 
"The real world implications of these findings bear directly on the front line treatment of depression. For that sizeable group of patients who are unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse," said Dr Zindel Segal. "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."
I know from my work at the NSW Institute of Psychiatry that many patients stop taking their antidepressants too soon either because of the side effects or because they don't like the idea of being on the drugs for years.
MBCT is being increasingly used as a psychotherapeutic approach for stress reduction, pain management, behaviour change, and for self-management of symptoms of depression. MBCT does not use drugs, but teaches patients how to be aware of and to a certain extent regulate emotions so they can spot triggers of relapse early, plus make changes in lifestyle that help them gain a sense of balance in mood and hold the gains for longer.

Now, what follows is most important. The researchers stressed that their findings highlighted how important it was for recurrently depressed patients whose remission is unstable to stay on at least one active long-term treatment. Further, if you want to stop taking an antidepressant, speak with your medical practitioner first and be guided by his or her advice. Do not stop taking any antidepressant abruptly without consulting with your medical practitioner who may recommend weaning your body off the medication gradually. People who stop an antidepressant too quickly may trigger antidepressant discontinuation syndrome which may result in rebound depression and other potentially serious problems.

Here is an abstract of the journal article, entitled “Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression”, by Zindel V Segal, Peter Bieling, Trevor Young, Glenda MacQueen, Robert Cooke, Lawrence Martin, Richard Bloch and Robert D Levitan, and published in Archives of General Psychiatry 2010 Dec; 67(12):1256-1264.

This post sets out a simple form of mindfulness sitting meditation.



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