- Is meditation, as a monotherapy or adjunctive therapy, more effective than treatment as usual, waitlists, no treatment, or other active treatments in reducing depressive symptoms, reducing relapse rates, improving health-related quality of life, and reducing antidepressant use in adults with major depressive disorder (MDD), and how common and severe are adverse events?
RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of mindfulness-based cognitive therapy (MBCT) — used adjunctively or as monotherapy — to assess its efficacy and safety in treating adults with major depressive disorder.
Outcomes of interest included depressive symptoms, relapse, health-related quality of life, and adverse events. Meta-analysis was performed with the Hartung-Knapp-Sidik-Jonkman method for random-effects models, a method suitable when the number of pooled studies is small and there is evidence of heterogeneity. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (or GRADE) approach.
In total, 17 studies met inclusion criteria. The evidence supports the use of adjunctive MBCT to reduce depressive symptoms among those currently depressed. The evidence also supports the use of adjunctive MBCT to reduce relapse among those with a history of at least three previous depressive episodes. Few studies examined relapse among those with a history of one or two previous depressive episodes. Very few studies assessed monotherapy MBCT, and the evidence was insufficient to determine its effect. Data on quality of life remains sparse, and adverse events have not been systematically assessed.
Evidence for Using Mindfulness-Based Cognitive Therapy to Treat MDD Is Limited
- The evidence supports the use of adjunctive MBCT to reduce depressive symptoms among those currently depressed. The evidence also supports the use of adjunctive MBCT to reduce relapse among those with a history of at least three previous depressive episodes.
- Evidence on the use of monotherapy MBCT is insufficient to draw conclusions about its efficacy, either to reduce depressive symptoms among those currently depressed or among those with a history of depression to reduce relapse.
- There is insufficient evidence on the effect of MBCT on health-related quality of life. Few studies examined the effect of MBCT on measures of health-related quality of life, and there was a lack of consistency in comparators used and the measures of health-related quality of life included.
- The evidence suggests that adjunctive MBCT does not significantly affect antidepressant use.
- The reported occurrence of adverse events was infrequent and did not appear to be related to MBCT. Only six of the included studies reported on adverse events.
- Additional studies are needed on the use of monotherapy MBCT to make conclusions about its efficacy, either to reduce depressive symptoms among those who are currently depressed or to reduce relapse among those with a history of depression. There is also insufficient evidence on the effect of MBCT on health-related quality of life, as well as a lack of standardized reporting of adverse events.
- Future studies should improve on the weaknesses pervasive in the current body of work, including suboptimal participant retention and a lack of true intention-to-treat analyses.
- Further research examining the effect of MBCT on depression should include samples large enough to allow results to be stratified by disease severity, include measures of health-related quality of life, and systematically assess adverse events.
This research was sponsored by the Office of the Secretary of Defense and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.
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