MBCT for recurrent depression: comparing the effectiveness of MBCT, antidepressant medication (ADM) and the combination of these interventions
Speaker: Marloes Huijbers; Anne Speckens, MD, PhD
Format: Audio & Slides

Objectives: A) To investigate the effectiveness of MBCT plus ADM compared to MBCT with discontinuation of ADM (trial 1), and compared to ADM only (trial 2). B) To investigate teacher competence and patient compliance with homework practices as possible factors associated with outcome.

Methods: Two parallel-group, multi-center randomized controlled trials with a 15-month study period. Three hundred seventeen adult outpatients with three or more previous depressive episodes, currently in full or partial remission and treated with ADM for a minimum period of 6 months were included. Participants were randomly allocated to MBCT with discontinuation of ADM or MBCT+ADM in trial 1 (N=249) or to ADM+MBCT or ADM in trial 2 (N=68). The primary outcome was depressive relapse, secondary outcome was depression severity. In addition, the relationship between teacher competency, patient compliance (amount of formal and informal exercises) and depression severity after MBCT was investigated.

Results: In trial 1, of the patients who discontinued their ADM per protocol in the MBCT/discontinuation condition, 69% relapsed, compared with 45% in the group who continued ADM after MBCT. Interestingly, depression severity during follow-up did not differ between the groups. In trial 2, relapse rates were similar for ADM + MBCT (36%) and ADM (37% ). We observed no effects of teacher competency or patient compliance with practice on the level of depression during the one year follow-up.

Conclusions: Discontinuation of ADM after MBCT significantly increased the relapse risk, although a proportional part of these relapses might be considered a rebound effect of withdrawal, and severity of depressive symptoms during the one year follow-up did not differ between the groups. MBCT did not have an additional effect to ADM in the group of patients who preferred to continue their medication. Furthermore, teacher competency and patient compliance were not associated with depression severity after MBCT.