title: A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression.
abstract: BACKGROUND
  Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of mindfulness-based cognitive therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD.
  
  
  METHODS
  This single-site, randomized controlled trial compared 8-week courses of MBCT and the Health Enhancement Program (HEP), comprising physical fitness, music therapy and nutritional education, as adjuncts to TAU pharmacotherapy for outpatient adults with TRD. The primary outcome was change in depression severity, measured by percent reduction in the total score on the 17-item Hamilton Depression Rating Scale (HAM-D17), with secondary depression indicators of treatment response and remission.
  
  
  RESULTS
  We enrolled 173 adults; mean length of a current depressive episode was 6.8 years (SD = 8.9). At the end of 8 weeks of treatment, a multivariate analysis showed that relative to the HEP condition, the MBCT condition was associated with a significantly greater mean percent reduction in the HAM-D17 (36.6 vs. 25.3%; p = 0.01) and a significantly higher rate of treatment responders (30.3 vs. 15.3%; p = 0.03). Although numerically superior for MBCT than for HEP, the rates of remission did not significantly differ between treatments (22.4 vs. 13.9%; p = 0.15). In these models, state anxiety, perceived stress and the presence of personality disorder had adverse effects on outcomes.
  
  
  CONCLUSIONS
  MBCT significantly decreased depression severity and improved treatment response rates at 8 weeks but not remission rates. MBCT appears to be a viable adjunct in the management of TRD.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, Calif., USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Eisendrath
authors.forename: Erin
authors.initials: E
authors.lastname: Gillung
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Delucchi
authors.forename: Zindel V
authors.initials: ZV
authors.lastname: Segal
authors.forename: J Craig
authors.initials: JC
authors.lastname: Nelson
authors.forename: L Alison
authors.initials: LA
authors.lastname: McInnes
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Mathalon
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Feldman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000628:therapy; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D055815:Young Adult
references.citation: Can J Psychiatry. 2007 Jan;52(1):46-54
references.pmid: 17444078
references.citation: J Pers Soc Psychol. 2003 Apr;84(4):822-48
references.pmid: 12703651
references.citation: Arch Gen Psychiatry. 2005 Sep;62(9):1007-14
references.pmid: 16143732
references.citation: Br J Soc Clin Psychol. 1967 Dec;6(4):278-96
references.pmid: 6080235
references.citation: J Clin Psychiatry. 2004 Mar;65(3):341-7
references.pmid: 15096073
references.citation: J Health Soc Behav. 1983 Dec;24(4):385-96
references.pmid: 6668417
references.citation: Psychother Psychosom. 2015;84(1):51-6
references.pmid: 25547778
references.citation: J Pers Soc Psychol. 1994 Jul;67(1):92-104
references.pmid: 8046585
references.citation: Psychiatr Clin North Am. 1996 Jun;19(2):179-200
references.pmid: 8827185
references.citation: Psychiatr Serv. 2002 Mar;53(3):288-92
references.pmid: 11875221
references.citation: Clin Psychol Rev. 2006 Oct;26(6):657-78
references.pmid: 15908088
references.citation: Behav Modif. 2011 May;35(3):265-83
references.pmid: 21362745
references.citation: PLoS One. 2013;8(8):e72778
references.pmid: 24009704
references.citation: Clin Psychol Rev. 2015 Apr;37:1-12
references.pmid: 25689576
references.citation: Arch Gen Psychiatry. 2009 Nov;66(11):1178-88
references.pmid: 19884606
references.citation: Int J Behav Med. 2005;12(2):111-22
references.pmid: 15901220
references.citation: Assessment. 2006 Mar;13(1):27-45
references.pmid: 16443717
references.citation: Cogn Behav Pract. 2011 Aug;18(3):362-370
references.pmid: 22211062
references.citation: Lancet. 2015 Jul 4;386(9988):63-73
references.pmid: 25907157
references.citation: J Clin Psychiatry. 2007 Jul;68(7):1062-70
references.pmid: 17685743
references.citation: J Consult Clin Psychol. 2004 Feb;72(1):31-40
references.pmid: 14756612
references.citation: Am J Psychiatry. 1996 Aug;153(8):985-92
references.pmid: 8678194
references.citation: Biol Psychiatry. 2007 Mar 15;61(6):729-30
references.pmid: 17338903
references.citation: J Clin Psychiatry. 2011 May;72(5):677-84
references.pmid: 21658349
references.citation: J Affect Disord. 2009 Jul;116(1-2):4-11
references.pmid: 19007996
references.citation: J Affect Disord. 2014 Mar;156:1-7
references.pmid: 24314926
references.citation: Psychiatry Res. 2008 Jul 15;163(2):143-55
references.pmid: 18455373
references.citation: Behav Res Ther. 2012 Jan;50(1):3-12
references.pmid: 22137364
references.citation: BMC Complement Altern Med. 2014;14:95
references.pmid: 24612825
references.citation: J Psychiatr Res. 2012 Mar;46(3):375-81
references.pmid: 22118808
references.citation: Psychother Psychosom. 2008;77(5):319-20
references.pmid: 18600038
references.citation: Dtsch Arztebl Int. 2014 Nov 7;111(45):766-75; quiz 775
references.pmid: 25467053
references.citation: J Neurosurg. 2012 Feb;116(2):315-22
references.pmid: 22098195
references.citation: Psychother Psychosom. 2014;83(2):70-88
references.pmid: 24458008
references.citation: Psychiatry Res. 2015 Apr 30;226(2-3):474-83
references.pmid: 25744325
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: J Consult Clin Psychol. 2000 Aug;68(4):615-23
references.pmid: 10965637
references.citation: J Clin Psychiatry. 2001;62 Suppl 16:26-31
references.pmid: 11480881
references.citation: Trials. 2010;11:99
references.pmid: 20961444
references.citation: J Consult Clin Psychol. 2012 Jun;80(3):365-72
references.pmid: 22409641
references.citation: N Engl J Med. 2000 May 18;342(20):1462-70
references.pmid: 10816183
references.citation: Group (New York). 2010 Dec 1;34(4):319-327
references.pmid: 25309026
references.citation: PLoS One. 2014;9(6):e97551
references.pmid: 24955584
references.citation: N Engl J Med. 2006 Mar 23;354(12):1243-52
references.pmid: 16554526
references.citation: Ann Clin Psychiatry. 2014 Aug;26(3):222-32
references.pmid: 25166485
references.citation: Psychol Assess. 2014 Jun;26(2):407-18
references.pmid: 24490681
references.citation: Behav Res Ther. 2009 May;47(5):366-73
references.pmid: 19249017
references.citation: Psychother Psychosom. 2014;83(4):197-204
references.pmid: 24969962
references.citation: J Consult Clin Psychol. 2014 Apr;82(2):275-86
references.pmid: 24294837
references.citation: Proc Natl Acad Sci U S A. 2003 Nov 25;100(24):14293-6
references.pmid: 14615578
references.citation: J Neurosci. 2009 Oct 21;29(42):13418-27
references.pmid: 19846729
references.citation: Am J Psychiatry. 2007 May;164(5):739-52
references.pmid: 17475733
references.citation: Behav Res Ther. 2006 Dec;44(12):1849-58
references.pmid: 16460668
references.citation: Am J Psychiatry. 2007 Aug;164(8):1189-97
references.pmid: 17671281
references.citation: Curr Psychiatry Rep. 2007 Dec;9(6):449-59
references.pmid: 18221624
references.citation: Prim Care Companion CNS Disord. 2014;16(3):null
references.pmid: 25317369
references.citation: Clin Psychol Rev. 2013 Dec;33(8):954-64
references.pmid: 23988455
references.citation: Depress Anxiety. 2012 Oct;29(10):896-905
references.pmid: 22767424
references.citation: Trends Cogn Sci. 2008 Apr;12(4):163-9
references.pmid: 18329323
references.citation: Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
references.pmid: 21135325
references.citation: Arch Gen Psychiatry. 1999 Sep;56(9):829-35
references.pmid: 12884889