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:
1Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
2Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands.
3Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.
4Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
5Department 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
BACK
