Summary

The MOMENT study investigated the effectiveness of mindfulness based cognitive therapy (MBCT) with or without antidepressant medication (ADM) for patients with recurrent depression. We conducted two randomized controlled trials (RCTs) in which we compared a) MBCT plus ADM and MBCT with discontinuation of ADM, and b) MBCT plus ADM and ADM alone. Up til now we have mainly been looking at depression outcomes and quality of life. We also examined the influence of teacher competency and patient preference on the outcomes. New analyses will be focusing on mechanisms of change, including the possible influence of adherence to homework practice.

Results

Contrary to our expectations we found that discontinuing ADM was associated with a significantly increased risk of relapse/recurrence: 69% for the patients who tapered completely, and 46% for the patients who continued their medication after MBCT. In addition, discontinuation of ADM appeared much more difficult than we had anticipated: almost half of the participants who were asked to stop their ADM kept using some or all of it. Surprisingly, the second RCT showed that patients who received MBCT plus ADM did not have a less risk of relapse/recurrence than patients using ADM alone.

Why

People who have suffered depressive episodes often keep using ADM to prevent a new depression. Although this works for a number of people, for others it is less effective. In addition, some people experience side effects of ADM, which leads them to search for an alternative. Previous studies have shown that MBCT appears to be at least as effective to prevent relapse/recurrence. However, it was still unclear if the combination of MBCT and ADM is more effective than either treatment on its own.

Goal

The primary research questions that we wanted to answer are a) “is it possible for patients with recurrent depression who have attended MBCT to discontinue their ADM without an increased risk of relapse/recurrence?”and b) “is the combination of MBCT and ADM more effective in preventing relapse/recurrence than either treatment on its own?”

Participants

Adults with a history of 3 or more episodes of depression, in full or partial remission at baseline, who had been using ADM for 6 months or longer.

Patients were recruited in 12 secondary and tertiary psychiatric out-patient clinics across the Netherlands: Radboudumc; VUmc / GGZ in Geest, Amsterdam;  AMC, Amsterdam; GGZ Leiden; GGZ Duin- en Bollenstreek, Lisse; Pro Persona Arnhem, Ede, Tiel en Nijmegen; PsyQ, Den Haag; Parnassia, Den Haag; GGZ Centraal, Amersfoort.

How

The research team assessed all participants every 3 months during the 15-month study period to see whether there had been a depressive relapse, the primary outcome measure. Additionally, the severity of (residual) depressive symptoms on a continuous scale, characteristics of any relapse (number, duration and severity) and quality of life were examined. Furthermore, participants filled out questionnaires about mindfulness, self-compassion and worrying, and registered their daily home practice.

When

Participants were recruited between September 2009 and January 2012. The final assessments took place in April 2013. The dissertation on the MOMENT study was defended on January 13, 2017. The new analyses examining working mechanisms and home practice are part of a new PhD project that has started September 1st, 2017.

By whom

PhD student: Marloes Huijbers

Supervisors: Prof. Dr. Anne Speckens, Prof. Dr. Philip Spinhoven, Prof. Dr. Jan Spijker.

Other project members: Dr. Eric Ruhé,  Dr. Anneke van Schaik, Prof. Dr. Patricia van Oppen, Prof. Dr. Willem Nolen, Prof. Dr. Johan Ormel, Prof. Dr. Willem Kuyken, Prof. Dr. Gert Jan van der Wilt, dr. Marc Blom, Prof. Dr. Aart Schene, Dr. Rogier Donders.

New PhD student: Marleen ter Avest

More information

Click HERE for the online version of the dissertation.

For more information contact Marloes Huijbers via
email: marloes.huijbers@radboudumc.nl or telephone: 0031-24–3610405.

Publications

 

 

  • Marleen ter Avest
    Marleen ter Avest phd student