Mindfulness As (In)Effective as Antidepressants at Preventing Relapses?

Rob Wipond
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A University of Oxford-led randomized controlled study published in The Lancet found that mindfulness-based cognitive therapy was as effective as antidepressants at preventing relapses in depressed people. The press release for the study noted this also meant that MBCT “isn’t any more effective” than maintenance antidepressant treatment in preventing relapses. However, the mindfulness group had to deal with another important confounding factor which the study authors only noted in passing.

The study involved 424 patients with a history of recurrent depression. Over 2 years, nearly half of the people in both the mindfulness group and the antidepressant group had relapsed (44% in the MBCT group vs 47% in the maintenance antidepressant medication group).

The authors stated that, “(W)hen considered in the context of the totality of randomised controlled data, we found evidence from this trial to support [mindfulness-based cognitive therapy] as an alternative to maintenance antidepressants for prevention of depressive relapse or recurrence at similar costs.”

The authors noted one limitation of the study was that the sample “consisted of a group of people at high risk of depressive relapse or recurrence.” The authors also noted — but did not factor into their evaluations of the results — that the entire group that were in the mindfulness arm had been taking antidepressants for some time and had to withdraw from them for the study. The authors described offering “support” for tapering, but did not include any information about how long the participants had been taking antidepressants for and how rapidly they came off them.

Other studies recently reported by Mad in America have found that withdrawal effects from antidepressants can be severe and long lasting and cause relapses.

Mindfulness-based therapy could offer an alternative to antidepressants for preventing depression relapse (The Lancet press release on ScienceDaily, April 20, 2015)

Kuyken, Willem, Rachel Hayes, Barbara Barrett, Richard Byng, Tim Dalgleish, David Kessler, Glyn Lewis, et al. “Effectiveness and Cost-Effectiveness of Mindfulness-Based Cognitive Therapy Compared with Maintenance Antidepressant Treatment in the Prevention of Depressive Relapse or Recurrence (PREVENT): A Randomised Controlled Trial.” The Lancet. Accessed April 27, 2015. doi:10.1016/S0140-6736(14)62222-4. (Abstract and full text)

19 COMMENTS

  1. Being mindful means being aware. When we practice mindfulness, we raise our awareness. When we raise our awareness, we learn new things. There is always new awareness to discover and there are always new things to learn. That never stops. If we want to stop experiencing depression, we can learn how to experience relief, joy, confidence, and happiness instead. Practice mindfulness daily, as a discipline, and there is no end to what one can learn.

      • Monica – I agree with you about Alex’s high quality off the cuff description–very normal for him. Also, your strict appraisal of the usual understanding of mindfulness remins me of another selling point of training yourself to become more mindful. To wit, besides the fact that just trying to learn how to be mindful benefits you noticeably, the things that might grate on your nerves more once you cool down and focus on the now tend to be the hang-ups and bang-ups that are ready to give way to new resiliency. You get to look at them over your shoulder for how much of a trap they were, without going through the agony of interpreting and analyzing them while you are unmindful, and so when you can’t think very practically about your emotions anyway.

      • P. S., Monica, Learning Ellen Langer’s particular language in the audio link you have on http://www.beyondmeds.com is nice for her take on more determinate refernce for language that instructs. I think that saying “when you’re there noticing things” is a great explication of “the now” and hadn’t meant to imply some one brand or method for tuning in in justing sifting through my awareness for adequate words. Folk psychology is thought much more apt, along the lines of how common sense ultimately deserves our mindful attention or respect, since many philosophers of psychology came to point out the elitism often motivating the anti-folk interpretations of our psychic life. In case you couldn’t think who got constantly so elitists, it was generally reductive materialists and those who take the scientific viewpoint to be superior by rights alone to any experientially founded one. I will try to begin recommending online shoppers to visit Amazon through your blog and look forward to more opportunities to catch up with the liberation politics of yours and Will’s.

      • I got through my withdrawal learning not only mindfulness, but also about how our body, mind, and spirit work as energy, specifically chakras as energy centers in the body which each correspond to different aspects of our being and life experience.

        Check out Carolyn Myss 1996 classic, Anatomy of the Spirit. I found it fascinating and life changing with respect to how I perceive ‘illness’ of any kind. For me it was a great and thorough introduction to perceiving ourselves as energy, which is where we have the power to shift anything. Before it manifests physically, energy is malleable, and is what everything physical is made of. Healing is the flip side of manifesting, so we not only have the power to heal, we have the power to manifest what our heart’s desire most–like a healthy and balanced mind, body, and spirit alignment.

        The way I perceive it, “psychosis” is a blend of vastly expanding consciousness which allows us to perceive beyond what is normally perceived, without being grounded. Mindfulness and meditation in general helps us to ground, that is, to feel our connection to the Earth, to feel that support and natural nourishment.

        Nature is extremely grounding. It’s where we find our center. So once we practice being mindful through meditation, we expand our awareness to include grounding, and then we can enjoy expanding consciousness without losing our grounding and center. No more ‘psychosis,’ just beautiful and exciting expanding awareness, from which we can manifest very creative and exciting things, to our liking, because we know ourselves and our process. That’s what comes from living mindfully.

        Many people label ‘psychotic’ simply that which they cannot understand or perceive, and which strikes fear in them. But if you felt your ‘psychosis’ as being chaotic for yourself, then, indeed, practicing mindfulness through GROUNDING is the ticket to preventing relapse, because not only does it increase awareness, it also brings you into synchronicity with yourself, calming the heart and mind. This allows us to manifest with more ease and clarity. It becomes a way of life, because it guides us toward inner peace, which I feel it what we want, at the end of it all.

        I wouldn’t necessarily call it ‘mindfulness therapy’ if only to dissociate this term as related to a healing modality. Mindfulness is a way of being, as opposed to being out of our bodies, in our heads, distracted with past issues or future worries. Changes the landscape of our personal realities.

        I hope this helps!

        • p.s. you also have to be around people who will acknowledge and support you for the light and gifts you bring with you, which we all do. That’s the best way to prevent madness or psychosis–know and honor who you are, 100%. Feel good about yourself, and find those that mirror this back to you.

          • Alex, many, many thanks. I am actually the mom, and I posed my question on behalf of my 20+ daughter who is recovering from a drug regimen that she should not have been on in the first place (an adverse reaction to antidepressants, leading to a bogus bipolar label and lots of drugging—you get the idea). What you say resonates a great deal and helps me help her. My daughter literally craves energy healing, which has been very helpful in her withdrawal. I have heard of Carolyn Myss and will get the book you mention (I read Barbara Brennan’s Hands of Light and became a believer). I agree with everything you say, but would also add that, in our case, nutrient (orthomolecular) therapy has proven to be surprisingly and extraordinarily helpful and effective. I believe in the body-mind-spirit connection and would leave no good healing option off the table. Many thanks again for your wise, beautifully expressed comments.

          • My pleasure GetItRight! Yes, nutrient replenishing is a vital part of it all. Our inner ecology and auto-immune system take a hit from the drugs, so it’s good we can rebuild this, strengthens our natural self-healing mechanisms, while balancing our system.

            What you say about your daughter sounds so encouraging! More than anything, healing is about our ability to RECEIVE the healing, so craving it shows a powerful desire to heal, which is wonderful and can only work in her favor. Sounds like you are well on track with this!

            Learning about chakras is so interesting and valuable, so doing it together is really pretty fun and enlightening.

            This is my area, precisely, I’m in integral healer, so if there is anything at all I can help you with, please don’t hesitate to shoot me an email. I’ve streamlined all that I learned during my journey of madness from psych meds and withdrawal (9 meds!), and can refer you to a variety of energy healing perspectives via internet, etc.

            Here’s my website, if you want to check it out, with contact info: http://www.embodycalm.com/Contact.html

  2. Moreover, so many of these studies that find other therapies “are as effective” and/or “aren’t more effective” than antidepressants, leave out the key, additional fact that the alternative therapy also isn’t toxic to your mind and body, as are the antidepressants.

    • …and the fact that data showing that anti-depressants are effective is shaky to say the least. It may well be that everything one does to the “depressed” person is at least good as an anti-depressant since it’s essentially placebo.

  6. The analytical omission by the authors (of the likely withdrawal effects) is amazing. I assume they felt they had to have a uniform population (i.e., all participants having been on SSRIs previously) but begs the question of whether they omitted the confounding effect simply to make the study look cleaner or because they really were unaware of the problem. Either way, that the reviewers also didn’t see or avoided the issue is a really good indicator of just how systemically screwed up the research system is.

    On a personal note, I had a very regular meditation practice while going through withdrawal and am quite sure I would have showed up in this study as a non-responder to meditation, simply because the withdrawal was so prolonged and awful.

  7. Actually I find this study to be quite compelling evidence in favor of MBCT. We know that individuals withdrawn off of maintenance antidepressants relapse at an alarmingly high rate when compared to individuals maintained on antidepressants (e.g., Hollon et al., 2005). Over the shorter term (1-2 years) maintenance meds are pretty good at preventing relapse, even though there may be other iatrogenic effects accumulating. So MBCT was at minimum able to overcome the known relapse rate associated with stopping the meds. That’s no small feat.

    The study also lasted only two years. We know that the relapse prevention effects of CBT and MBCT actually increase in comparison to medication maintenance over the longer term (e.g., Bockting et al., 2009). I suspect when longer-term follow-ups are conducted, these authors will observe the same effects.

    • according to Irvine Kirsch that could be because the damaging effects of anti-depressants cause some people to be depressed (sexual problems, fall in the elderly, miscarriages and birth defects can all cause deperssion for example). The main effect of both of these treatments is the raising of hope but one does not have serious medical effects.

    • Nick Forand – I am glad you put the emphasis where you thought it was important. The problem with any talk therapy just is the ease and convenience and the status and entitlements that await the psychologist happy enough to be an apparatchik for the standard psychitric run of services. People don’t miss the fact that the psychologists around here insist that you can’t make someone change, that they have to decide it, and that when they meet the psychologist inhospital the shift in the semantics of “force” has changed the nature of their freedom to choose anything for themselves. Rather their attention on and considerations of the contradiction is suppressed and their behaviors and dispositions changed according to all the ostensibly therapeutic options confronting them. I wish the data in these clinical settings was gathered as rigorously as for any naturalistic experiment in behavioral modification is when the intentions are to get something accomplished, as opposed to insisting that something did. For instance, researches who want to help sell gum will more carefully investigate responses and frame their objective measurement efforts more significantly in terms of common sense. Honesty pays where it has to, and with entitlements it needn’t count for much.

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