Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial.


Author: Cladder-Micus MB1,2,3, Speckens AEM3, Vrijsen JN2,4, T Donders AR5, Becker ES1, Spijker J1,2

Affiliation: <sup>1</sup>Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.

<sup>2</sup>Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands.

<sup>3</sup>Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.

<sup>4</sup>Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.

<sup>5</sup>Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Conference/Journal: Depress Anxiety.
Date published: 2018 Aug 8
Other:
  Special Notes: doi: 10.1002/da.22788. [Epub ahead of print]   ,  Word Count: 271  
    BACKGROUND: Chronic and treatment-resistant depressions pose serious problems in mental health care. Mindfulness-based cognitive therapy (MBCT) is an effective treatment for remitted and currently depressed patients. It is, however, unknown whether MBCT is effective for chronic, treatment-resistant depressed patients.



METHOD: A pragmatic, multicenter, randomized-controlled trial was conducted comparing treatment-as-usual (TAU) with MBCT + TAU in 106 chronically depressed outpatients who previously received pharmacotherapy (≥4 weeks) and psychological treatment (≥10 sessions).



RESULTS: Based on the intention-to-treat (ITT) analysis, participants in the MBCT + TAU condition did not have significantly fewer depressive symptoms than those in the TAU condition (-3.23 [-6.99 to 0.54], d = 0.35, P = 0.09) at posttreatment. However, compared to TAU, the MBCT + TAU group reported significantly higher remission rates (χ2 (2) = 4.25, φ = 0.22, P = 0.04), lower levels of rumination (-3.85 [-7.55 to -0.15], d = 0.39, P = 0.04), a higher quality of life (4.42 [0.03-8.81], d = 0.42, P = 0.048), more mindfulness skills (11.25 [6.09-16.40], d = 0.73, P < 0.001), and more self-compassion (2.91 [1.17-4.65], d = 0.64, P = 0.001). The percentage of non-completers in the MBCT + TAU condition was relatively high (n = 12, 24.5%). Per-protocol analyses revealed that those who completed MBCT + TAU had significantly fewer depressive symptoms at posttreatment compared to participants receiving TAU (-4.24 [-8.38 to -0.11], d = 0.45, P = 0.04).



CONCLUSION: Although the ITT analysis did not reveal a significant reduction in depressive symptoms of MBCT + TAU over TAU, MBCT + TAU seems to have beneficial effects for chronic, treatment-resistant depressed patients in terms of remission rates, rumination, quality of life, mindfulness skills, and self-compassion. Additionally, patients who completed MBCT showed significant reductions in depressive symptoms. Reasons for non-completion should be further investigated.



© 2018 The Authors. Depression and Anxiety published by Wiley Periodicals, Inc.



KEYWORDS: depressive disorder; mindfulness; quality of life; randomized controlled trial; treatment-resistant depression



PMID: 30088834  DOI: 10.1002/da.22788