Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial

Marloes J Huijbers; Philip Spinhoven; Jan Spijker; Henricus G Ruhé; Digna J F van Schaik; Patricia van Oppen; Willem A Nolen; Johan Ormel; Willem Kuyken; Gert Jan van der Wilt; Marc B J Blom; Aart H Schene; A Rogier; T Donders; Anne E M Speckens

doi:10.1192/bjp.bp.115.168971

Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial

Br J Psychiatry. 2016 Apr;208(4):366-73. doi: 10.1192/bjp.bp.115.168971. Epub 2016 Feb 18.

Authors

Affiliations

¹ Marloes J. Huijbers, MSc, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Philip Spinhoven, PhD, Institute of Psychology, Leiden University, Leiden and Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Jan Spijker, PhD, MD, Pro Persona Nijmegen, Nijmegen, The Netherlands; Henricus G. Ruhé, PhD, MD, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Digna J. F. van Schaik, PhD, MD, Patricia van Oppen, PhD, GGZ InGeest and Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands, Willem A. Nolen, PhD, MD, Johan Ormel, PhD, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Willem Kuyken, PhD, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Gert Jan van der Wilt, PhD, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Marc B. J. Blom, PhD, MD, Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands; Aart H. Schene, PhD, MD, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; A. Rogier T. Donders, PhD, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Anne E. M. Speckens, PhD, MD, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands marloes.huijbers@radboudumc.nl.
² Marloes J. Huijbers, MSc, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Philip Spinhoven, PhD, Institute of Psychology, Leiden University, Leiden and Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Jan Spijker, PhD, MD, Pro Persona Nijmegen, Nijmegen, The Netherlands; Henricus G. Ruhé, PhD, MD, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Digna J. F. van Schaik, PhD, MD, Patricia van Oppen, PhD, GGZ InGeest and Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands, Willem A. Nolen, PhD, MD, Johan Ormel, PhD, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Willem Kuyken, PhD, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Gert Jan van der Wilt, PhD, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Marc B. J. Blom, PhD, MD, Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands; Aart H. Schene, PhD, MD, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; A. Rogier T. Donders, PhD, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Anne E. M. Speckens, PhD, MD, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.

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.

Aims: To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM.

Method: A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov:NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n= 249), were randomly allocated to either discontinue (n= 128) or continue (n= 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity.

Results: The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity.

Conclusions: Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Antidepressive Agents / administration & dosage*
Antidepressive Agents / therapeutic use
Cognitive Behavioral Therapy*
Combined Modality Therapy
Depressive Disorder, Major / drug therapy
Depressive Disorder, Major / therapy*
Female
Humans
Male
Middle Aged
Mindfulness*
Recurrence
Secondary Prevention / methods
Treatment Outcome

Substances

Antidepressive Agents

Associated data

ClinicalTrials.gov/NCT00928980