Does mindfulness therapy prevent depression relapse?
Yes. Mindfulness-based cognitive therapy (MBCT) lowered the risk of depression coming back in people who had recovered from repeated episodes. An individual patient data meta-analysis pooled 9 randomized trials with 1,258 participants. Over 60 weeks, 38% of people who got MBCT relapsed, compared with 49% of those who did not. That works out to about 1 fewer relapse for every 9 people treated. Relapse risk was about 31% lower with MBCT than without it (hazard ratio 0.69, 95% CI 0.58 to 0.82). In the trials that compared MBCT with other active treatments, including maintenance antidepressants, relapse risk was about 21% lower with MBCT (hazard ratio 0.79, 95% CI 0.64 to 0.97).
MBCT combines systematic mindfulness training with elements of cognitive therapy. It teaches skills aimed at the thinking patterns that set up a depressive relapse, for people who are currently well but at high risk.
What the data show:
- Relapse rates: 38% of MBCT participants (229 of 596) relapsed within 60 weeks, compared with 49% of those not receiving MBCT (327 of 662)
- Versus all comparison groups: About 31% lower relapse risk with MBCT (hazard ratio 0.69)
- Versus maintenance antidepressants: About 23% lower relapse risk with MBCT, based on 4 trials (hazard ratio 0.77, 95% CI 0.60 to 0.98)
- Study scope: 9 randomized trials, 1,258 participants with recurrent depression in full or partial remission
- Who it worked for: The effect did not differ by age, sex, education, or relationship status. People with more depression symptoms at the start got more benefit
An individual patient data meta-analysis published in JAMA Psychiatry combined the raw patient data from 9 randomized trials. This let the researchers ask not only whether MBCT works but for whom.
Dr. Kumar’s Take
Keeping people well after they recover from depression is one of the hardest parts of treatment. Maintenance antidepressants are the standard way to do it. This analysis shows that MBCT, a skills-based therapy, held up against that standard. In at least one of those trials, people in the MBCT group also stayed on their medication. In the trials that compared the two head to head, relapse risk was lower with MBCT, not just equal.
Two details matter to me. First, the people with more leftover symptoms at the start got the most benefit, and people with fewer symptoms were not harmed by it. Second, the protection faded somewhat over the 60 weeks. MBCT is a real option for people with recurrent depression, but it is not a one-time fix, and the choice between MBCT and medication, or both, belongs with your doctor.
Study Snapshot
The researchers updated an earlier meta-analysis. They searched EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register through November 2014. They included randomized trials of MBCT delivered by its treatment manual, in adults with recurrent major depression in full or partial remission, compared with at least one other treatment, including usual care. Ten trials qualified. The raw data were available for 9. The main outcome was relapse into major depression within 60 weeks, judged by standard diagnostic criteria such as DSM-IV.
Results in Real Numbers
The analysis included 1,258 participants from 9 trials: 596 received MBCT and 662 did not. The average age was 47 years, and 75% were women. More than half (58%) had had 5 or more past episodes of depression.
Over 60 weeks, 38% of the MBCT group relapsed, compared with 49% of the comparison groups. That is an absolute difference of about 11 percentage points, or roughly 1 fewer relapse for every 9 people given MBCT. In relative terms, relapse risk was about 31% lower with MBCT (hazard ratio 0.69).
Against other active treatments, using 5 trials, relapse risk was about 21% lower with MBCT (hazard ratio 0.79). Against maintenance antidepressants alone, using 4 trials, it was about 23% lower (hazard ratio 0.77).
The effect of MBCT did not differ by age, sex, education, relationship status, age when depression first began, or number of past episodes. People with more severe depression symptoms before treatment got a larger benefit. People with lower symptoms got less benefit but were not worse off.
The protective effect of MBCT became smaller over time during the 60-week follow-up. Adverse events were formally recorded in 6 of the 9 trials, and none were attributed to MBCT.
Who Benefits Most
MBCT was designed for people with recurrent depression who are currently well but at high risk of relapse. This is the group the trials studied.
Within that group, people who still had more depression symptoms at the start benefited most. The benefit did not depend on age, sex, education, relationship status, age at first depression, or number of past episodes.
Safety, Limits, and Caveats
No adverse events were attributed to MBCT, but only 6 of the 9 trials formally recorded them. The benefit shrank over the 60-week follow-up. The comparisons with antidepressants rest on 4 trials.
The authors point out other limits. The trials were largely run by researchers who favor MBCT, which can inflate results. A funnel plot suggested that some small studies showing worse results with MBCT may be missing. Data from one eligible trial were not available.
Practical Takeaways
- MBCT lowered relapse risk in people with recurrent depression who were currently in remission
- In the trials that compared it with maintenance antidepressants, relapse risk was lower with MBCT
- People with more leftover symptoms got the most benefit
- The protective effect faded somewhat over 60 weeks
- Do not stop an antidepressant on your own; discuss MBCT with your doctor as an alternative or an addition
What This Means for Depression Treatment
Antidepressants are the current first-line approach for preventing relapse. This meta-analysis shows that MBCT, a non-drug treatment, lowered relapse risk compared with usual care and compared with other active treatments, including antidepressants. It supports MBCT as an option for people with recurrent depression, especially those with ongoing symptoms. The authors call for trials with active control groups, longer follow-up, and systematic reporting of adverse events.
Related Studies and Research
- Episode 31: Depression Explained, The Biology Behind the Darkness
- Episode 32: Depression Recovery Roadmap: A Step-by-Step, Evidence-Based Plan
FAQs
How is MBCT different from regular mindfulness meditation?
MBCT combines systematic mindfulness training with elements of cognitive therapy. It is delivered according to a treatment manual and aims at the thinking patterns that set up a depressive relapse.
Can MBCT completely replace antidepressants for relapse prevention?
In the 4 trials that compared them, relapse risk was about 23% lower with MBCT than with maintenance antidepressants. That is a small number of trials, and the benefit faded somewhat over time. The decision should be made with your doctor, and no one should stop an antidepressant on their own.
How long does MBCT treatment take?
The trials delivered MBCT according to its treatment manual and followed people for up to 60 weeks for relapse. Ask your therapist about the length of a specific course.
Bottom Line
In 9 randomized trials with 1,258 people with recurrent depression in remission, MBCT lowered relapse over 60 weeks: 38% relapsed with MBCT versus 49% without it. Relapse risk was also lower than with maintenance antidepressants in the 4 trials that compared them. The benefit was largest in people with more leftover symptoms and faded somewhat over time.
