Mindfulness therapy helps treatment-resistant depression, cohort study shows
According to new research, mindfulness-based cognitive therapy (MBCT) is superior to therapy focused on exercise and healthy eating in patients with treatment-resistant depression. “Practicing Alternatives to Heal Depression” is the title of the study that was conducted by investigators at the University of California at San Francisco.
The study participants and criteria
The study was a single-blind randomized trial that included 173 patients with treatment-resistant major depressive disorder (TR-MDD), which was defined as failure to remit with two or more antidepressants. Inclusion criteria for the study participants included the following:
- A Hamilton Depression total score of at least 14
- Taking at least two antidepressant medications
- Receiving no form of psychotherapy
- Having no substance abuse problem
- Having no history of a psychotic disorder
- A Mini-Mental State Examination score of at least 25
After screening for the inclusion criteria elements, the investigators randomly assigned patients to one of two group-based interventions: mindfulness-based cognitive therapy (MBCT) and the Health Enhancement Program (HEP). The MBCT group learned mindfulness techniques, which included sitting meditation and elements of cognitive-behavioral therapy. The HEP group focused on physical fitness, nutritional counseling and music therapy. Both groups continued to take their prescribed medicated regimen and completed approximately two hours of the same physical exercise per week as well as 45 minutes of the same homework related to both HEP and MBCT therapies.
The study continued for the duration of eight weeks. Results were measured by comparing the initial Hamilton Depression scores of participants before they entered the therapy groups to their Hamilton Depression scores after completion of the study.
After eight weeks of the intervention, both groups improved, but the change in the Hamilton Depression score in the MBCT group was 36.6 percent vs. 25.3 percent for the HEP group. As for treatment response, again the MBCT group came out on top, with 29.58 percent of the sample achieving a 50 percent or greater reduction in the Hamilton Depression total score compared with 17.19 percent in the HEP group. The findings were presented at the American Psychiatric Association 2015 Annual Meeting.
How depression affects the brain
One theory explaining the underlying mechanisms of TR-MDD is that cognitive control mechanisms are deficient. Cognitive control enables people to flexibly switch between different thoughts and actions to appropriately guide their behavior.
To help test that hypothesis, researchers carried out a pre- and post-functional MRI study on a subgroup of 88 patients, 44 patients from each of the two groups: the MBCT group and the HEP group. Participants completed an emotional working memory task while undergoing functional magnetic resonance imaging.
Compared with the HEP patients, those in the MBCT group had enhanced dorsolateral prefrontal cortex activity. This area is associated with executive control of depression and with memory function activity. These subjects also showed reduced activation in the ventrolateral prefrontal cortex during the working memory performance.
This analysis showed that, among patients who had been practicing mindfulness, specific effects on areas of the brain’s circuitry play a role in depression. In addition, improved depressive symptoms in the MBCT group were associated with enhanced regulation of amygdala activity during the working memory performance.
This study proves that psychotherapy can be effective. The sole use of medication is not advised for treating depression in all its forms, from mild and moderate to the more severe treatment-resistant depression. Sovereign Health Group incorporates meditation and cognitive-behavioral therapy in its customized treatment programs for depression and other mental health disorders. For more information, please call 888-530-4614.
Written by Kristen Fuller, M.D., Sovereign Health Group writer