For those trying to get off of antidepressants, here's more proof that self-awareness/meditation improves your well-being

From MedPage Daily, "For patients who achieve an unstable remission after depression -- one dotted with depressive symptoms -- mindfulness-based cognitive therapy may prevent relapse just as well as maintenance antidepressant therapy, researchers say.

Both treatments were equivalent and were associated with similar reductions in relapse compared with placebo, Zindel Segal, PhD, of the Center for Addiction and Mental Health in Toronto, and colleagues reported in the Archives of General Psychiatry.

"For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse," they wrote.
Relapse after recovery from depression is common, and the current therapy to prevent relapse is maintenance antidepressants. Medication adherence, however, tends to be an issue.

Mindfulness-based cognitive therapy may be an alternative, the researchers said. The group-based regimen helps train patients to disengage from depressogenic thinking, and puts an emphasis on daily practice of health-enhancing behaviors such as meditation or yoga.

Yet little data on its efficacy exists. So the researchers conducted a randomized trial of 166 patients ages 18 to 65 at two outpatient clinics in Canada who met criteria for major depressive disorder, and focused on the 84 who achieved remission. These patients were assigned to one of the three groups: antidepressant maintenance therapy, mindfulness-based cognitive therapy, or placebo.

Patients who received cognitive therapy discontinued their antidepressants and attended eight weekly group sessions.

During their acute treatment phase, about half (51%) of patients were classified as unstable remitters, while the rest were stable.

These unstable remitters had higher depression scores, spent more days in the acute treatment phase, and spent more days in remission than those who were stable (P=0.03, P=0.02, and P=0.03, respectively).

Thus there was a significant interaction between quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P=0.03).

"Our findings indicated that the quality of remission achieved during the acute phase interacted with the type of prevention treatment patients received to determine relapse outcomes during the subsequent maintenance phase," the researchers wrote.

So they assessed treatment effects among the unstable group. They found that all of these treated patients -- whether they had mindfulness-based therapy or antidepressant therapy -- had a reduction in relapse risk compared with placebo, which didn't differ significantly between the two groups.

Relapse rates were 27% for antidepressant maintenance therapy, 28% for mindfulness therapy, and 71% for placebo.

Individually, mindfulness therapy was associated with a 74% reduced risk of relapse (95% CI 0.09 to 0.79, P=0.01), and antidepressant therapy was associated with a 76% reduced risk (95% CI 0.07 to 0.89, P=0.03).

"For patients whose acute-phase remission was marked by periodic symptom flurries, discontinuing [antidepressants] and receiving [cognitive therapy], or continuing with [antidepressants] significantly lowered relapse/recurrence risk compared with discontinuation to placebo," they wrote.

They said the results are "in accord with previous reports" that time in remission or the presence of residual symptoms are associated with "poorer acute- and maintenance-phase outcomes" and that reduction of this risk "with targeted treatment is beneficial."

"Surprisingly, for patients whose acute-phase remission was stable, there was no differential effect on survival between the treatments we studied," they added.

The study was limited because its power was lessened when the cohort was divided into stable and unstable remitters, and the authors noted that further study is needed.

Link to the article's abstract - http://archpsyc.ama-assn.org/cgi/content/short/67/12/1256