Discontinuing antidepressant medication after mindfulness-based cognitive therapy: a mixed-methods study exploring predictors and outcomes of different discontinuation trajectories, and its facilitators and barriers
Marloes J. Huijbers, Carolien Wentink, Anne E. M. Speckens, Esther Simons, Jan Spijker
BMJ Open November 12, 2020 DOI: 10.1136/bmjopen-2020-039053 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Mixed-methods study Randomized Qualitative Peer reviewed |
|---|---|
| Sample size | 226 |
| Population | Recurrently depressed adults in partial or full remission who had used antidepressants for at least 6 months |
| Intervention | Mindfulness-based cognitive therapy (MBCT) |
| Duration | 6-month discontinuation period, 15-month follow-up |
| Topics | Meditation |
| Registration | NCT00928980 |
| Key points | Only 53% of participants fully discontinued antidepressants within 6 months; full discontinuation was associated with female sex, employment, and lower depression levels. Relapse risk was higher after full discontinuation (66%) than after partial (38%) or no discontinuation (45%). |
Abstract
Objectives This study aimed to explore predictors and outcomes associated with different trajectories of discontinuing antidepressant medication (ADM), in recurrently depressed individuals after participation in mindfulness-based cognitive therapy (MBCT). Facilitators and barriers of discontinuation were explored qualitatively.Design Mixed-methods study combining quantitative and qualitative data, drawn from a randomised controlled trial.Setting Twelve secondary and tertiary psychiatric outpatient clinics in the Netherlands.Participants Recurrently depressed individuals (N=226) who had been using ADM for at least 6 months and in partial or full remission. Regardless of trial condition, we made post-hoc classifications of patients’ actual discontinuation trajectories: full discontinuation (n=82), partial discontinuation (n=34) and no discontinuation (n=110) of ADM within 6 months after baseline. A subset of patients (n=15) and physicians (n=7) were interviewed to examine facilitators and barriers of discontinuation.Interventions All participants were offered MBCT, which consisted of eight weekly sessions in a group.Primary and secondary outcome measures Demographic and clinical predictors of successful discontinuation within 6 months, relapse risk within 15 months associated with different discontinuation trajectories, and barriers and facilitators of discontinuation.Results Of the 128 patients assigned to MBCT with discontinuation, only 68 (53%) fully discontinued ADM within 6 months, and 17 (13%) discontinued partially. Predictors of full discontinuation were female sex, being employed and lower levels of depression. Relapse risk was lower after no discontinuation (45%) or partial discontinuation (38%), compared with full discontinuation (66%) (p=0.02). Facilitators and barriers of discontinuation were clustered within five themes: (1) pre-existing beliefs about depression, medication and tapering; (2) current experience with ADM; (3) life circumstances; (4) clinical support and (5) mindfulness.Conclusions Discontinuing antidepressants appears to be difficult, stressing the need to support patients and physicians in this process. MBCT may offer one of these forms of support.Trial registration number ClinicalTrials.gov Registry (NCT00928980); post-results.
Comparable studies
Other qualitative studies on meditation, most cited first.
Citations in the library
Cites 5
- Mindfulness-based cognitive therapy for depression August 21, 2006
- Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse JAMA Psychiatry April 28, 2016
- Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial. The British Journal of Psychiatry April 2016
- Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial The Lancet July 4, 2015
- Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology December 1, 2008