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Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.
Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
Publication Type
Zindel V Segal
Peter Bieling
Trevor Young
Glenda MacQueen
Robert Cooke
Lawrence Martin
Richard Bloch
Robert D Levitan
Author Affiliation
Centre for Addiction and Mental Health, Toronto, ON, Canada.
Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
Publication Type
Antidepressive Agents - administration & dosage - therapeutic use
Cognitive Therapy - methods
Combined Modality Therapy - methods
Depressive Disorder, Major - drug therapy - prevention & control - psychology
Diagnostic and Statistical Manual of Mental Disorders
Drug Administration Schedule
Follow-Up Studies
Middle Aged
Outpatients - psychology
Psychiatric Status Rating Scales
Psychotherapy, Group - methods
Recurrence - prevention & control
Treatment Outcome
Young Adult
Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse.
To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care.
Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were randomized to receive maintenance antidepressant medication, MBCT, or placebo and were followed up for 18 months.
Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph's Healthcare, Hamilton, Ontario.
One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to 1 of the 3 study conditions.
Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT, continued taking their therapeutic dose of antidepressant medication, or discontinued active medication and were switched to placebo.
Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV.
Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P = .03). Among unstable remitters (1 or more Hamilton Rating Scale for Depression score >7 during remission), patients in both MBCT and maintenance treatment showed a 73% decrease in hazard compared with placebo (P = .03), whereas for stable remitters (all Hamilton Rating Scale for Depression scores =7 during remission) there were no group differences in survival.
For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters.
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PubMed ID
21135325 View in PubMed
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