Mindfulness-based cognitive therapy is not superior to maintenance antidepressants in preventing depression recurrence or relapse [PREVENT trial]

1. This single-blind, multicenter, randomized controlled trial found that mindfulness-based cognitive therapy with support to taper or discontinue antidepressant therapy did not significantly reduce depression relapses or recurrences within 24 months of follow-up in participants diagnosed with recurrent major depressive disorder, compared to maintenance antidepressant therapy.

2. Both treatments, however, were associated with positive outcomes in reducing rates of relapses or recurrences.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Without treatment, individuals with depression are more likely to suffer recurrences and relapses throughout their lives. In those with a history of recurrent depression, antidepressant treatment for at least two years is the current standard for preventing recurrences and relapses, however, many patients may prefer other options besides medications to treat their depression. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce rates or relapse or recurrence of depression compared to placebo or standard care. This study compared MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) against maintenance antidepressants in the prevention of relapses and recurrences over 24 months.

The results showed that MBCT-TS did not significantly reduce relapses or recurrences of depression over the 24 month follow-up period, compared to maintenance antidepressant therapy. However, both treatment methods provided similar positive outcomes in reductions of rates of depression relapse or recurrence. Strengths of the study included a larger sample size and longer follow-up than previous similar studies. Limitations of the study included a lack of a control group for usual care and including participants who were open to considering both group psychosocial treatment and discontinuing antidepressant treatment, limiting applicability to those who may be considering other treatments.

Click to read the study in The Lancet

Relevant Reading: Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: a randomized dismantling trial

In-Depth [randomized controlled trial]: The PREVENT trial was a multicenter, single-blind, parallel, randomized controlled trial conducted between March 2010 and October 2011 in the UK. 424 adults aged 18 and older who were diagnosed with recurrent major depressive disorder according to DSM-IV criteria, suffered three or more major depressive episodes, and were on maintenance antidepressants were included in the study. Participants were randomized (1:1) to receive either maintenance antidepressants or 8 weeks of MBCT-TS class. Research assessors were blinded to treatment, while participants and clinicians were aware of treatment allocation. The primary outcome was time to depression relapse or recurrence within 24 months, assessed at five follow-up intervals.

189 (89%) participants in the MBCT-TS group and 194 (92%) in the antidepressant group completed the study. The results showed that MBCT-TS did not significantly reduce relapse or recurrence compared to antidepressant treatment (hazard ratio [HR] 0.89, 95% Confidence Interval [CI] 0.67-1.18, p=0.43), with similar rates of relapse in each group, with 94 (44%) participants in the MBCT-TS group compared to 100 (47%) in the antidepressant group (p=0.41).

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