Mindfulness therapy may be as good as meds for depression

Mindfulness-based cognitive therapy might offer an alternative for people with depression who don't want to take antidepressants long-term, British researchers say.

Their study, published April 21 online in The Lancet, found this new therapy was as effective as antidepressant drugs in preventing a recurrence of depression over a two-year period.

"Depression frequently is a recurring and relapsing disorder. People suffering from it are wise to look at ways of maintaining wellness after their depressive symptoms have resolved," said Dr. Roger Mulder, head of psychological medicine at the University of Otago in New Zealand. "Mindfulness-based cognitive therapy appears to offer one way of doing this."

"There are alternatives to remaining well after being depressed besides being on long-term medication," added Mulder, who wrote an editorial accompanying the study. The mindfulness therapy appears to cost no more than medication and has no side effects, he noted.

Mindfulness-based cognitive therapy brings together two treatment approaches. Guided mindfulness practices, which aim to increase awareness of negative spirals, are combined with aspects of cognitive behavioral training, a short-term therapy that teaches skills to help resist or counter damaging thoughts or moods.

The program is intended to train the mind and body to respond more constructively to experiences in hopes of preventing another slide into depression, said the researchers, led by Willem Kuyken, a professor of clinical psychology at the University of Oxford in England.

Mindfulness cognitive therapy is catching on in the United States, said Simon Rego, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City.

"Much like with cognitive behavioral therapy, people being treated with mindfulness therapy initially see their therapist on a weekly basis and then taper off to less frequent sessions as skills are built before ending the treatment," he said.

In the new study, 424 people with major depression were assigned to either mindfulness-based cognitive therapy or to antidepressants. Over two years, the relapse rates were similar -- 44 percent in the therapy group and 47 percent in the medication group.

The therapy participants attended eight group sessions each lasting two and a quarter hours. They were also given techniques to practice at home. Therapy sessions included guided mindfulness practices, group discussion and other behavioral exercises. After the sessions ended, they had the option of attending four more sessions over a year.

Those assigned to antidepressants continued their medication for two years, the researchers said.

Tony Tang, an adjunct professor in the department of psychology at the University of Pennsylvania, is skeptical about the need for mindfulness therapy to prevent relapses of depression.

"Nobody really knows how mindfulness cognitive therapy works," he said.

"We understand cognitive therapy a great deal by now. It works by teaching patients how to examine and refute their unrealistically negative thoughts. Mindfulness training comes from an Eastern meditation tradition. How it prevents depression is still a mystery," Tang said.

Cognitive therapy alone can help prevent depression relapses, Tang said. "So, I am not convinced yet that the addition of mindfulness training is absolutely necessary," he said.

But some patients might find standard cognitive therapy too logical and dry, Tang said.

"Adding the mindfulness training might make the package more appealing to many clients," he said. "It also fits in better with the current fashion for New Age alternative care. When working with real-world patients, these are actually important considerations."