A recent study shows that cognitive therapy combined with daily practice of meditation, yoga, and other health-enhancing behaviors can be as effective as long-term antidepressant medication alone in preventing relapse in patients who have had several bouts of major depression.

The hybrid treatment, known as mindfulness-based cognitive therapy (MBCT), is a psychosocial group intervention focused on teaching patients how to disengage from thoughts and behaviors that put them at risk for relapse. Zindel V. Segal, a professor of psychiatry at the University of Toronto Centre for Addiction and Mental Health and one of the researchers who developed MBCT, said it "provides another treatment option for those who are unwilling or unable to continue taking antidepressant medications."

The eight-week program includes daily exercises aimed at increasing nonjudgmental awareness of thoughts, feelings, and bodily sensations; encouraging the acceptance of difficulties with more self-compassion; and developing an "action plan" to respond to early warning signs of relapse. Once the new cognitive self-management skills are learned, patients can continue practicing them after the group intervention ends.

Seeking to find out how MBCT stacks up against standard pharmacologic maintenance, the researchers compared the rates of relapse among three groups of patients with recurrent depression (N = 84): those who received MBCT; those who stayed on antidepressant monotherapy; and those who received a placebo (all had been in remission for a minimum of seven months after receiving treatment with antidepressant medication). The latter two groups received clinical management from psychiatrists blinded to treatment assignment. All patients were monitored weekly for relapse, defined as a return of symptoms that met the criteria for major depression in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, for at least two weeks.

The researchers followed the patients for up to 18 months and found that the protective effects of MBCT and pharmacologic maintenance were essentially the same. Relapse rates were 27% in the medicated group, 28% in the MBCT group, and 71% in the group receiving placebo. MBCT reduced the risk of relapse by 74%, relative to placebo, compared with 76% for antidepressants.

For more on MBCT, see http://www.mbct.com.-James M. Stubenrauch