SOURCE: Kuyken W, et al. 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. Lancet 2015;386:63-73.

After an initial episode of depression, unless preventive treatment is initiated, recurrence is the rule rather than the exception (50-80%). As a result, national guidelines support maintenance treatment, especially for persons with demonstrated recurrence or with other high-risk indicators (e.g., history of bipolar disorder, family history of recurrences, or early age at initial diagnosis). The United Kingdom NICE Guidelines endorse at least 2 years of maintenance antidepressants when depression is recurrent.

PREVENT was a randomized, controlled trial (n = 424) comparing mindfulness-based cognitive therapy (MBCT) to antidepressant pharmacotherapy for prevention of depression recurrence. Inclusion required at least three prior episodes of major depression. Study subjects randomized to MBCT had been on pharmacotherapy, which was tapered/discontinued during the MBCT phase of treatment (71% fully discontinued, 17% reduced dose, 13% no dose reduction [total > 100% due to rounding]).

Over a 24-month interval, slightly fewer than half of the subjects experienced relapse (44-47%), with no significant difference demonstrable between MBCT and pharmacotherapy.

The comparable efficacy of MBCT and pharmacotherapy should prompt clinicians to offer patients treatment as per their preference.