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Mindfulness therapy prevents relapse of depression

It is unclear exactly how mindfulness-based therapy works, but it may change neural pathways to support patterns that lead to recovery instead of to deeper depression.

Mindfulness therapy prevents relapse of depression

For patients who achieve an unstable remission after depression - one dotted with depressive symptoms - mindfulness-based cognitive therapy may prevent relapse or recurrence just as well as maintenance antidepressant therapy.

Relapse after recovery from major depression is common, and the current therapy to prevent relapse is maintenance therapy with a single antidepressant. This regimen is generally effective if patients take their medications, but as many as 40 percent of them do not. Medication adherence, thus, tends to be an issue. Alternatives to long-term antidepressant therapy, especially those that address mood outcomes in a broader context of well-being, may appeal to patients wary of continued intervention. Mindfulness-based cognitive therapy may be an alternative. The group-based regimen helps train patients to disengage from depressogenic thinking, and puts an emphasis on daily practice of health-enhancing behaviors such as meditation or yoga. The patients are taught to monitor and observe their thinking patterns when they feel sad, changing automatic reactions associated with depression (such as rumination and avoidance) into opportunities for useful reflection. This is accomplished through daily homework exercises featuring guided (taped) awareness exercises directed at increasing moment-by-moment nonjudgmental awareness of bodily sensations, thoughts, and feelings; accepting difficulties with a stance of self-compassion; and developing an 'action plan' composed of strategies for responding to early warning signs of relapse/recurrence.

Yet little data on its efficacy exists. So, researchers in Canada conducted a randomised trial of 160 patients aged between 18 and 65 years at two outpatient clinics in Ontario who met criteria for major depressive disorder and had experienced at least two episodes of depression. They focused on the 84 who achieved remission after eight months of treatment. These patients were assigned to one of the three groups - antidepressant maintenance therapy, mindfulness-based cognitive therapy or placebo.

During the 18-month follow-up period, relapse occurred among 38 percent of those in the cognitive behavioral therapy group, 46 percent of those in the maintenance medication group and 60 percent of those in the placebo group, making both medication and behavioral therapy effective at preventing relapse.

About half (51 percent) of patients were classified as unstable remitters, defined as individuals who had symptom "flurries" or intermittently higher scores on depression rating scales despite having a low enough average score to qualify for remission. The other half (49 percent) were stable remitters with consistently low scores. Among unstable remitters, those taking maintenance medication or undergoing cognitive behavioral therapy were about 73 percent less likely to relapse than those taking placebo. Among stable remitters, there were no differences between the three groups.

The study emphasised the importance of maintaining at least one active long-term treatment in recurrently depressed patients whose remission is unstable. For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse compared with placebo. It is unclear exactly how mindfulness-based therapy works, but it may change neural pathways to support patterns that lead to recovery instead of to deeper depression.
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