Factors associated with relapse and recurrence of major depressive disorder in patients starting mindfulness-based cognitive therapy.
Study Goal
The researchers aimed to investigate the association of cognitive reactivity, rumination, self-compassion, and mindfulness with relapse in remitted MDD patients before initiating MBCT.
Results Summary
Higher cognitive reactivity and lower mindfulness were associated with increased relapse risk, while self-compassion showed no association. Rumination was linked to relapse only in patients discontinuing antidepressant medication.
Population
282 remitted MDD participants with ≥3 depressive episodes, using maintenance antidepressant medication for at least 6 months.
Effective Dosage
Not specified
Duration
Not specified
Interactions
Interaction noted with maintenance antidepressant medication (mADM) for rumination.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Mindfulness-based cognitive therapy (MBCT) | decrease | relapse prevention | major depressive disorder (MDD) | - | is effective for | #1 |
Mindfulness-based cognitive therapy (MBCT) | decrease | cognitive reactivity (CR) | major depressive disorder (MDD) | - | reduces | #2 |
Mindfulness-based cognitive therapy (MBCT) | decrease | rumination | major depressive disorder (MDD) | - | reduces | #3 |
Mindfulness-based cognitive therapy (MBCT) | increase | self-compassion | major depressive disorder (MDD) | - | enhances | #4 |
Mindfulness-based cognitive therapy (MBCT) | increase | mindfulness | major depressive disorder (MDD) | - | enhances | #5 |
- | neutral | relapse | remitted MDD participants | - | were associated with | #6 |
- | increase | risk of relapse | remitted MDD participants | - | Higher CR | #7 |
- | increase | risk of relapse | remitted MDD participants | - | lower mindfulness | #8 |
- | no change | relapse | remitted MDD participants | - | was not associated with | #9 |
- | neutral | relapse | patients who discontinued their mADM | - | was associated with | #10 |
- | no change | relapse | patients who continued mADM | - | effect was absent | #11 |
BACKGROUND: Mindfulness-based cognitive therapy (MBCT) is effective for relapse prevention in major depressive disorder (MDD). It reduces cognitive reactivity (CR) and rumination, and enhances self-compassion and mindfulness. Although rumination and mindfulness after MBCT are associated with relapse, the association of CR, rumination, self-compassion, and mindfulness with relapse before initiation of MBCT has never been investigated. METHODS: Data were drawn from two randomized controlled trials, including a total of 282 remitted MDD participants (≥3 depressive episodes) who had been using maintenance antidepressant medication (mADM) for at least 6 months before baseline. All participants were offered MBCT while either their mADM was maintained or discontinued after MBCT. CR, rumination, self-compassion, and mindfulness were assessed at baseline by self-rated questionnaires and were used in Cox proportional hazards regression models to investigate their association with relapse. RESULTS: CR and mindfulness were associated with relapse, independent of residual symptoms, previous depressive episodes, and mADM-use. Higher CR and lower mindfulness increased the risk of relapse. Self-compassion was not associated with relapse. For rumination, a significant interaction with mADM-use was found. Rumination was associated with relapse in patients who discontinued their mADM, while this effect was absent if patients continued mADM. CONCLUSIONS: These results show that CR, rumination, and mindfulness are associated with relapse in remitted MDD-patients before initiation of MBCT, independent of residual symptoms and previous depressive episodes. This information could improve decisions in treatment planning in remitted individuals with a history of depression.