Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial.
Study Goal
To investigate whether mindfulness-based cognitive therapy (MBCT) with discontinuation of maintenance antidepressant medication (mADM) is non-inferior to MBCT combined with continued mADM in preventing depressive relapse.
Results Summary
The study found that discontinuing mADM after MBCT led to a higher relapse/recurrence rate and shorter time to relapse compared to continuing mADM, though depression severity differences were minor. The results suggest an increased relapse risk when withdrawing from mADM post-MBCT.
Population
Adults with recurrent depression in remission who had been using mADM for 6 months or longer (n=249).
Effective Dosage
Not specified
Duration
15 months (follow-up period)
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Mindfulness-based cognitive therapy (MBCT) | decrease | relapse in recurrent depression | adults with recurrent depression in remission | - | reduce the risk of | #1 |
maintenance antidepressant medication (mADM) | decrease | relapse in recurrent depression | adults with recurrent depression in remission | - | reduce the risk of | #2 |
MBCT with discontinuation of mADM | increase | relapse/recurrence rates | adults with recurrent depression in remission, using mADM for 6 months or longer | 25% | exceeded the non-inferiority margin | #3 |
discontinuation of mADM after MBCT | decrease | time to relapse/recurrence | adults with recurrent depression in remission, using mADM for 6 months or longer | - | was significantly shorter | #4 |
discontinuation of mADM after MBCT | no change | depression severity | adults with recurrent depression in remission, using mADM for 6 months or longer | - | only minor differences | #5 |
withdrawing from mADM after MBCT | increase | relapse/recurrence | patients | - | increased risk of | #6 |
BACKGROUND: Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. AIMS: To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM. METHOD: A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov:NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n= 249), were randomly allocated to either discontinue (n= 128) or continue (n= 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity. RESULTS: The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity. CONCLUSIONS: Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.