Is mindfulness therapy as good as pills for depression?

Mindfulness-based cognitive therapy may be as good as pills at stopping people relapsing after recovering from major bouts of depression, according to a study.

Mindfulness-based cognitive therapy (MBCT) was developed from mindfulness techniques, which encourage individuals to pay more attention to the present moment, combined with cognitive behaviour therapy (CBT), specifically to try to help people who have recurring depression.

It teaches people to recognise that negative thoughts and feelings will return, but that they can disengage from them. Rather than worrying constantly about them, people can become aware of them, understand them and accept them, and avoid being dragged down into a spiral leading back to depression.

As a qualified counsellor working in the Hastings area, I am able to use a number of therapies, including mindfulness, to help clients with depression.

Current best practice, endorsed by Nice (the National Institute for Health and Care Excellence) is to encourage people with a history of recurrent depression to remain on antidepressants for at least two years.

However, some are very reluctant to keep taking pills, while others find their depression comes back when they finally stop using the tablets.

The trial, published in The Lancet, involved a group of 424 adults from GP practices in the south-west of England, who were willing to try either the pills or the therapy. Half were randomly allotted to each. Those assigned to mindfulness had eight group sessions of more than two hours plus daily home practice and the option of four follow-up sessions over a year. The course involved mindfulness training, group discussion and cognitive behaviour exercises. The patients gradually came off their medication. Those assigned to the other group stayed on the tablets for two years.

The relapse rates in the two groups were similar, with 44% in the mindfulness group and 47% for those on the drugs.

The researchers, from the University of Plymouth, had thought the study might show that therapy was more effective than pills, based on their earlier work. However, they established that mindfulness-based therapy is equally as good as drugs, which could offer a new option for those who do not want to be on medication for years.

The study also showed that the therapy might work better than pills for those who have some of the most troubled histories and are at the highest risk of relapse. It was found to have protected people with increased risk because of a background of childhood abuse. The paper’s authors wondered whether MBCT confers resilience in this group at highest risk because patients learn skills that address some of the underlying mechanisms of relapse or recurrence.

Depression remains a disabling condition. Despite the increased use of drugs, the long-term outcome of mood disorders has not improved in the modern era. Having an alternative non-medication strategy to reduce relapse is an important means to help patients with depression.

 

added at 12:04am on 21st April 2015

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