Mindfulness-based cognitive therapy (MBCT) is a cost-effective treatment option for adults with major depressive disorder (MDD) who have not achieved remission through standard psychological therapies, a new study showed.
Compared with treatment as usual (TAU), addition of MBCT achieved a greater reduction in depressive symptoms, with benefits sustained up to 6 months later. Improvements in participants' work and social functioning were also observed.
"We know there's a gap in services for people with depression who haven't got better through National Health Service [NHS] Talking Therapies," study coauthor Barney Dunn, PhD, from University of Exeter, Exeter, England, said in a statement.
"These people often don't qualify for further specialist mental health care, and so, are left with no further options. We've shown that offering MBCT to this group can be effective and cost-efficient to deliver, and we hope this will lead to it being implemented widely," said Dunn.
The study was published online on May 14 in Lancet Psychiatry.
It's estimated that about half of individuals with MDD fail to achieve remission after psychological therapy within the UK NHS Talking Therapies program.
MBCT offers a promising nondrug option, leveraging mindfulness training to counter habitual maladaptive thinking. However, no large trials had conclusively tested its efficacy and cost-effectiveness in psychological therapy nonremitters until now.
In a randomized controlled superiority trial conducted across 20 NHS services in the United Kingdom, 234 adults (mean age, 42 years; 71% women) who did not reach remission after 12 or more sessions of high-intensity therapy were assigned to MBCT plus TAU or TAU alone.
MBCT consisted of eight weekly group-based sessions delivered by videoconferences and teaching mindfulness skills and how to respond more effectively to difficult emotions.
Six months after treatment, patients in the MBCT group had significantly lower levels of depression symptoms than peers in the TAU-only group, with an adjusted between-group difference on the Patient Heath Questionnaire-9 of 2.49 points (P = .0006).
The average effect of MBCT was in the small to moderate range, similar to other trials of psychological treatment for MDD and comparable to treatment with antidepressants. Effects were maintained up to 6 months after treatment ended, the study team said.
MBCT plus TAU was superior to TAU alone in reducing symptoms of generalized anxiety and increasing mental wellbeing more broadly.
Based on economic analyses, MBCT had an estimated 99% chance of being cost-effective at a threshold of £20,000 per quality-adjusted life year gained and a 91% probability of being less costly and more effective than TAU alone, the study team found.
No serious trial-related adverse events were observed.
This study adds "robust" evidence to existing research and brings the combined evidence to a level at which MBCT "should be considered for guideline endorsement as a further-line treatment in the UK," the investigators concluded.
In a statement from the nonprofit UK Science Media Centre, Jesús Montero-Marín, PhD, Department of Psychiatry, University of Oxford, Oxford, England, said this study is a "major advance in the treatment of resistant depression."
"This work provides conclusive evidence that MBCT can be an effective and cost-effective second-line treatment option in structured clinical settings. Its implementation could lead to a substantial improvement in the continuity of care for cases of difficult-to-treat depression," said Montero-Marín.
Also weighing in, Elena Makovac, PhD, senior lecturer in clinical psychology, Brunel University of London, London, England pointed out a key limitation of the study.
"By comparing MCBT plus treatment as usual with the treatment-as-usual group, we cannot definitively determine whether the observed improvements were specifically due to the MCBT or if they resulted from the fact that the MCBT group received more treatment overall compared to the control group. This improvement could potentially have been achieved with an extension of the originally delivered Talking Therapies," Makovac said in the statement.
"While research into additional treatments for difficult-to-treat depression is essential, it is even more important to offer interventions grounded in well-understood mechanisms. This process begins with a crucial first step: Answering the question of why some patients do not respond to talking therapies," Makovac added.