New treatment for recurring depression
DECEMBER 01, 2008
New research shows, for the first time, that a group-based psychological treatment, Mindfulness Based Cognitive Therapy (MBCT), could be a viable alternative to prescription drugs for people suffering from long-term depression. Research from a collaboration between the University of Exeter and the Institute of Psychiatry at King’s has been published in the Journal Consulting and Clinical Psychology’s December issue.
The study into MBCT shows that it is as effective as maintenance anti-depressants in preventing a relapse and more effective in enhancing peoples’ quality of life. It also indicates that MBCT may be as cost-effective as prescription drugs in helping people with a history of depression stay well in the longer-term.
Funded by the Medical Research Council (MRC), the study was led by Professor Willem Kuyken at the Mood Disorders Centre, University of Exeter, in collaboration with colleagues at the Centre for Economics of Mental Health (CEMH) at the Institute of Psychiatry, King’s College London, Peninsula Medical School, Devon Primary Care Trust and the Medical Research Council Cognition and Brain Sciences Unit.
The randomised control trial involved 123 people from urban and rural locations who had suffered repeat depressions and were referred to the trial by their GPs. The participants were split randomly into two groups. Half continued their on-going anti-depressant drug treatment and the rest participated in an MBCT course and were given the option of coming off anti-depressants.
Over the 15 months after the trial, 47% of the group following the MBCT course experienced a relapse compared with 60% of those continuing their normal treatment, including anti-depressant drugs. In addition, the group on the MBCT programme reported a higher quality of life, in terms of their overall enjoyment of daily living and physical well-being.
Members of the study team from the Institute of Psychiatry, King’s College London compared the cost of providing MBCT programmes, compared with the cost of maintenance anti-depressant treatment. The findings suggest that MBCT may provide a cost-effective alternative to anti-depressant drugs.
Unlike most other psychological therapies, MBCT can be taught in groups by a single therapist, and patients then continue to practice the skills they have learned at home by themselves. Therefore, MBCT is less costly than individual treatments and is not dependent on having the large number of trained therapists needed for one-to-one psychological treatments so could help the National Health Service shorten its waiting lists for psychological therapies.
During the eight-week trial, groups of between eight and fifteen people met with one therapist. They learned a range of meditation exercises that they could continue to practice on their own once the course ended. Many of the exercises were based on Buddhist meditation techniques and helped the individual take time to focus on the present, rather than dwelling on past events, or planning for future tasks. The exercises worked in a different way for each person, but many reported greater acceptance of, and more control over, negative thoughts and feelings.
Professor Willem Kuyken of the University of Exeter said: “Anti-depressants are widely used by people who suffer from depression and that’s because they tend to work. But, while they’re very effective in helping reduce the symptoms of depression, when people come off them they are particularly vulnerable to relapse. MBCT takes a different approach – it teaches people skills for life. What we have shown is that when people work at it, these skills for life help keep people well.”
Professor Kuyken continues: “Our results suggest MBCT may be a viable alternative for some of the 3.5 million people in the UK known to be suffering from this debilitating condition. I think we have the basis for offering patients and GPs an alternative to long-term anti-depressant medication. We are planning to conduct a larger trial to put these results to the test and to examine how MBCT works.”
Dr Sarah Byford, who led the economic evaluation at the Institute of Psychiatry at King’s said: “The group-based nature of MBCT offers a more cost-effective solution for long-term depression than prescription drugs or individual therapy.”