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Which treatments might help avoid depression relapse?

More than half of people who experience depression once will go on to have at least one more episode. For people who have experienced several periods of depression, recurrence rates can be as high as 80%, even if an individual episode was treated successfully.

A new NIHR study has found that mindfulness-based cognitive therapy (MBCT) may be a viable alternative to anti-depressants in preventing depression relapse. MBCT is a type of cognitive therapy that uses mindfulness techniques in addition to CBT techniques to help avoid negative thought patterns. There is already good quality evidence to suggest that MBCT is more effective than usual care in preventing relapse, but to date there had been no large trials to test whether MBCT could work better than anti-depressants.

At present, the National Institute for Health and Care Excellence (NICE) recommends that people with a history of recurrent depression should take maintenance anti-depressant medication for up to two years. This medication can have side effects and some people find they are unable to keep taking it for the recommended length of time, or would like an alternative to medication.

The NIHR trial recruited over 400 people, then randomly allocated them to one group who continued with their normal maintenance anti-depressants, or another group who tapered off their medication and received a course of MBCT. After two years, there was no evidence of a difference in rates of depression relapse between the two groups: 44% of the MBCT group had experienced a relapse compared to 47% of the medication group. There was little difference in other outcomes, such as number of depression-free days and quality of life.

The study also found some indication that MBCT may have been particularly effective for people who had experienced more severe childhood abuse. There is evidence that a history of childhood abuse is linked to poorer outcomes for people with depression, so an alternative form of therapy could be very useful. However this analysis was based on a small sub-group of patients and would need more research to confirm it.

This study compared MBCT with anti-depressants, but not with a group who received no treatment, soit is difficult to draw firm conclusions about the overall effectiveness of MBCT. However, there is good evidence that maintenance anti-depressant medication can reduce the chances of a relapse compared with no medication or other intervention. The results suggest that MBCT is likely to have similar benefits, so although MBCT wasn’t significantly better than medication, it could be an option for some people who would prefer not to stay on anti-depressants.

The cost of MBCT was found to be similar to that of anti-depressant medication over the two-year period studied. When other costs – such as productivity losses – were calculated, these were also similar for the two therapies. Cost-effectiveness was no better for MBCT than for anti-depressant treatment, but since costs and outcomes were similar, it appears to provide a reasonable alternative from a cost perspective.

The NIHR is funding an ongoing study to explore why provision of MBCT services remains uneven in some areas, and how it could be improved – you can read a blog about the emerging findings here.

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