title: Adding mindfulness-based cognitive therapy to maintenance antidepressant medication for prevention of relapse/recurrence in major depressive disorder: Randomised controlled trial.
abstract: 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. Our aim was to investigate whether the addition of MBCT to mADM is a more effective prevention strategy than mADM alone.
  
  
  METHODS
  This study is one of two multicenter randomised trials comparing the combination of MBCT and mADM to either intervention on its own. In the current trial, recurrently depressed patients in remission who had been using mADM for 6 months or longer (n=68), were randomly allocated to either MBCT+mADM (n=33) or mADM alone (n=35). Primary outcome was depressive relapse/recurrence within 15 months. Key secondary outcomes were time to relapse/recurrence and depression severity. Analyses were based on intention-to-treat.
  
  
  RESULTS
  There were no significant differences between the groups on any of the outcome measures.
  
  
  CONCLUSIONS
  The current study included patients who had recovered from depression with mADM and who preferred the certainty of continuing medication to the possibility of participating in MBCT. Lower expectations of mindfulness in the current trial, compared with the parallel trial, may have caused selection bias. In addition, recruitment was hampered by the increasing availability of MBCT in the Netherlands, and even about a quarter of participants included in the trial who were allocated to the control group chose to get MBCT elsewhere.
  
  
  CONCLUSIONS
  For this selection of recurrently depressed patients in remission and using mADM for 6 months or longer, MBCT did not further reduce their risk for relapse/recurrence or their (residual) depressive symptoms.
authors: Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands. Electronic address: marloes.huijbers@radboudumc.nl.
authors: Marloes J
authors: MJ
authors: Huijbers
authors: Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors: Philip
authors: P
authors: Spinhoven
authors: Pro Persona Nijmegen, Reinier Postlaan 6, 6525 GC Nijmegen, The Netherlands.
authors: Jan
authors: J
authors: Spijker
authors: Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
authors: Henricus G
authors: HG
authors: Ruhé
authors: GGZ InGeest and VU University Medical Center, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands.
authors: Digna J F
authors: DJ
authors: van Schaik
authors: GGZ InGeest and VU University Medical Center, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands.
authors: Patricia
authors: P
authors: van Oppen
authors: Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
authors: Willem A
authors: WA
authors: Nolen
authors: Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
authors: Johan
authors: J
authors: Ormel
authors: Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK.
authors: Willem
authors: W
authors: Kuyken
authors: Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands.
authors: Gert Jan
authors: GJ
authors: van der Wilt
authors: Parnassia Bavo Psychiatric Institute, Lijnbaan 4, 2512 VA The Hague, The Netherlands.
authors: Marc B J
authors: MB
authors: Blom
authors: Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands.
authors: Aart H
authors: AH
authors: Schene
authors: Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands.
authors: A Rogier T
authors: AR
authors: Donders
authors: Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands.
authors: Anne E M
authors: AE
authors: Speckens
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D009426:Netherlands; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant medication; Depressive disorder; Mindfulness; Prevention; Randomized controlled trial