Mindfulness-based cognitive therapy was associated with a reduced risk of depressive relapse over a 60-week follow-up period compared with usual care, and outcomes were comparable to those who received other active treatments, according to an article published online by JAMA Psychiatry.

Recurrent depression causes significant disability. Interventions that prevent depressive relapse could help reduce the burden of this disease. A growing body of research suggests mindfulness-based cognitive therapy (MBCT) is efficacious.

Willem Kuyken, Ph.D., of the University of Oxford, England, and coauthors report the results of analyses of individual patient data from nine published randomized trials of MBCT. The analyses included 1,258 patients with available data on relapse and examined the efficacy of MBCT compared with usual care and other active treatments, including antidepressants.

This meta-analysis, included data from trials that compared MBCT to usual care as well as to other active treatments such as maintenance antidepressants – the current mainstay approach to prevention of depressive relapse.

The authors report MBCT was associated with reduced risk of depressive relapse/recurrence over 60 weeks compared with those who did not receive MBCT. There also appears to be no differing effects for patients based on their sex, age, education or relationship status.

Across the nine trials, 38% of those who received MBCT had a depressive relapse within 60 weeks' follow-up, in contrast to 49% of those who did not receive MBCT. Taking the time to relapse into account, people who received MBCT were 31% less likely to relapse during the 60-week follow-up compared with those who did not receive MBCT.

The treatment effect of MBCT on the risk of depressive relapse/recurrence also may be larger in patients with higher levels of depression symptoms at baseline compared with non-MBCT treatments, according to the results. The authors suggest this means that MBCT may be especially helpful to those patients who still have significant depressive symptoms.

The authors acknowledge study limitations related to the availability of the data within the studies.

"We recommend that future trials consider an active control group, use comparable primary and secondary outcomes, use longer follow-ups, report treatment fidelity, collect key background variables (e.g., race/ethnicity and employment), take care to ensure generalizability, conduct cost-effectiveness analyses, put in place ethical and data management procedures that enable data sharing, consider mechanisms of action, and systematically record and report adverse events," the authors conclude.

This work was supported by Wellcome Trust. Drs. Kuyken, Taylor, Byford, and Byng were partially supported by the National Institute for Health Research Healthy Technology Assessment program. Drs. Taylor and Byng have also been supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter National Health Service Foundation Trust. Drs. Schweizer and Dalgleish were supported by the Medical Research Council.