Lancet study on mindfulness-based therapy

The Lancet has published a research study on mindfulness-based cognitive therapy (MBCT) for depression. The full text of the study, entitled “Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial”. For non-scientists, Lancet also put out a press release summarizing the study, entitled “Mindfulness-based therapy could offer an alternative to antidepressants for preventing depression relapse”. Lancet also published a “linked comment” by Roger Mulder entitled “Depression relapse: importance of a long-term perspective”. Many news outlets, including WebMD and The Independent, have run articles about this study.

The study looks specifically at ways of preventing a recurrence or relapse of depression in people who have recovered from a major depression. Mulder explains, “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.”

This is a valuable perspective. Many people are just prone to depression. If you’re one of those people, developing good coping strategies should be an ongoing lifelong process, even during stretches when you’re feeling relatively strong.

Researchers specifically compared two types of treatment for maintaining wellness after a bout of serious depression: antidepressant drug therapy vs mindfulness-based cognitive therapy. The study found the two treatment programs roughly equal in effectiveness over a two-year period.

Some thoughts:

Most commentators frame the issue as antidepressants vs mindfulness. Even the Lancet press release calls mindfulness-based cognitive therapy “an alternative to antidepressants”. I find this opposition unnecessary and unproductive.

For researchers, dividing study participants into one group receiving only antidepressant drug therapy and another group receiving only MBCT makes methodological sense. But real-world depression sufferers need not face such a stark choice. There’s no reason you can’t incorporate antidepressant drugs AND mindfulness-based cognitive therapy into a multi-front approach to fighting depression.

The very idea of “mindfulness-based cognitive therapy” is itself a combination of approaches. Cognitive therapy mainly involves recognizing and changing your negative thought patterns, while mindfulness mainly involves meditation. Both can be extremely valuable. The developers of MBCT wisely chose not to consider these two practices as mutually-exclusive alternatives, but instead to combine them into a broader strategy.

Smash Depression advocates a variety of approaches to coping with depression, including:

No one of these approaches is a magic bullet, the one true key to beating depression. None of these approaches need conflict with any other approach. You can do cognitive therapy exercises AND do yoga AND cut back on junk food and alcohol AND practice meditation AND normalize your sleep schedule AND take Zoloft or Wellbutrin. These are not “alternatives”, they are complementary parts of a broad life plan.

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