Treating patients whose depression is in remission with preventive cognitive therapy (PCT) or mindfulness-based cognitive therapy (MBCT) as they taper an antidepressant medication appears to be a safe alternative to maintenance antidepressant therapy, suggests a report in JAMA Psychiatry.
“Current clinical guidelines recommend the continued use of antidepressant medication for patients at high risk for depressive relapse,” wrote Claudi L. Bockting, Ph.D., of Amsterdam University Medical Center and colleagues. “These results suggest that even for patients with a poor clinical prognosis, it may be possible to recommend offering PCT or MBCT during and after tapering of antidepressants as an alternative to continuing the use of antidepressants.”
Bockting and colleagues performed a literature search for studies that compared adults with depression fully or partially in remission who received preventive psychological intervention while being tapered off their antidepressant with those who continued antidepressant treatment only. Six studies met the researchers’ criteria; the researchers were able to obtain individual patient data for four of these studies (714 patients total), which made up the final sample. Three of the studies involved patients who received MBCT during the tapering period; the fourth involved patients who received PCT during and/or after the tapering period.
The researchers specifically compared whether the patients who received the psychological interventions while tapering antidepressants differed in time to depressive relapse compared with those who continued to take antidepressants. Relapse of depression was measured using the Structured Clinical Interview for DSM-IV Axis I disorders.
Bockting and colleagues found no significant difference in time to relapse between use of a psychological intervention during the tapering period versus antidepressant therapy alone. Younger age at onset, shorter duration of remission, and higher levels of residual depressive symptoms at baseline were associated with a higher overall risk of relapse.
“Although these findings suggest that psychological interventions may be an alternative for continued antidepressant medication use for all individuals, collaborative decision-making between patients and practitioners is crucial,” the authors concluded.
For related information, see the Psychiatric News article “AJP Board Member Responds to NYT Story on Antidepressant Withdrawal.”
(Image: iStock/Zinkevych)
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