Depressive recurrence is a common clinical situation causing several serious complications. First, the risk of recurrence increases with the number of depressive episodes, reaching 90% beyond three episodes. The risks of chronic depression, suicide, stress sensitization and hippocampal changes are also increasing with depressive recurrences.
1Assistant Professor of Psychiatry, Psychiatry department, Mohammed-V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco. 2Medical Intern, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco. 3Professor of Psychiatry, Psychiatry department, Mohammed-V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Dr. Yassine OTHMAN, Assistant Professor of Psychiatry, Psychiatry department, Mohammed-V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Madinat Al Irfane, 10100, Rabat, Morocco; Email: email@example.com
Depressive recurrence is a common clinical situation causing several serious complications. First, the risk of recurrence increases with the number of depressive episodes, reaching 90% beyond three episodes . The risks of chronic depression, suicide, stress sensitization, and hippocampal changes are also increasing with depressive recurrences [2,3]. This makes the prevention of depressive recurrence a priority in the management of patients with depressive episodes. Apart from antidepressants (AD), few psychotherapies have proven their efficacy in preventing a depressive relapse. Among these therapies, mindfulness-based cognitive therapy (MBCT) is one of the most promising. Here we will present the results of a systematic review conducted in the context of an undergoing medical thesis.
This systematic review analyzed 10 randomized controlled clinical trials (RCTs), comparing MBCT with 4 different control conditions. In the 4 RCTs that compared it with usual treatment (UT) (n = 416) [4-7], 3 RCTs showed that MBCT with UT was significantly superior to UT alone in preventing depressive recurrence for patients with 3 previous depressive episodes or more [4,5,7]. Nevertheless, for patients with only 2 depressive episodes, 2 RCTs showed no superiority of MBCT [4,5]. The 3 RCTs (n = 631) that compared patients on maintenance AD, with MBCT patients who decreased or discontinued AD, all showed that MBCT is as effective as an antidepressant in the prevention of depressive recurrence [8-10].
However, for patients with a childhood abuse history, MBCT is more effective than maintenance AD . Only one RCT (n = 68) compared the MBCT + AD combination with maintenance-only AD treatment, concluding that there is no difference in the prevention of depressive recurrence between these 2 groups . Finally, and in comparison with maintenance psychotherapies, 2 RCTs (n = 361) were performed showing that MBCT is as effective as these 2 psychotherapies in preventing depressive recurrence [12,13]. However, for patients with a high score of trauma in their childhood, MBCT is significantly more effective .
In light of these results, we deduce that MBCT is:
- effective in preventing depressive recurrence as an adjunctive therapy;
a possible alternative to reduce, or stop the maintenance antidepressant treatment, without increasing the risk of depressive recurrence; - more beneficial for patients at higher risk of recurrence (patients with more than two previous episodes, patients who have experienced childhood abuse or trauma.
These results also raise other questions about the profile of the patients who respond best to this therapy compared to other therapeutic means, in order to choose the best solution for each patient. MBCT may also be a promising therapeutic option for other clinical presentations like social anxiety and post-traumatic stress disorder, but further research is needed.
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