Mindfulness for recurrent depression: its positive potential and the vast unknown
Dr Bergljot Gjelsvik, Dr Laura Taylor and Daniel Brett, from the Oxford Mindfulness Centre at the University of Oxford, explain what we’ve learnt so far from research into mindfulness for recurrent depression and what we still need to find out.
Mindfulness practice is everywhere. Not only is it recommended by the National Institute for Health and Care Excellence (NICE) guidelines as an intervention for people with recurrent depression, you may have kids who’ve done it at school, your workplace might be offering mindfulness sessions during your lunch break, or perhaps you have picked up one of the many books on the subject promising to teach you the skills. However, despite the buzz, there’s a lot more we need to find out. To do that, we need thorough scientific research.
Whilst it is well established that mindfulness-based cognitive therapy (MBCT) helps people with recurrent depression stay well, it’s our job to discover who benefits and why they benefit, as well as other potential applications of mindfulness practice for mental health.
Mindfulness-based cognitive therapy
MBCT, the specific type of mindfulness-based intervention which we study, is designed to teach people a different way of interacting with their thoughts and feelings – a so-called ‘decentered’ way of thinking. The intention is for people to learn to observe the thoughts and feelings they are experiencing, rather than immediately reacting to them.
MBCT was developed to help prevent people from relapsing if they’ve had depression before. If someone experiences depression once in their life, there’s a 50 per cent risk that they will again. Each time it comes back, their odds worsen. Once they’ve had it three times, there’s a 90 per cent chance they’ll relapse.
It’s important to understand what might trigger a possible relapse – triggers may be very specific to an individual’s situation and can be influenced by external or internal factors. For example, someone who’s had depression may start to think in ways that make them vulnerable to the illness returning, characterised by a tendency to take thoughts as truths, and to try and get rid of thoughts or ruminate about them. We’re trying to find out more about how that processing works, and how it might affect treatment.
What we know so far
You may have seen headlines earlier this year saying that MBCT is as effective as anti-depressant drugs for people with recurrent depression. This coverage came from a study analysing data from nine previous trials of MBCT, involving 1,258 patients. In four of the trials, MBCT (combined with continuation, tapering, or discontinuation of antidepressants) was compared to continued antidepressant treatment alone. Data from these trials showed that those who received MBCT, and in many cases tapered or discontinued antidepressant medication, were 23 per cent less likely to relapse to major depression than those who continued on antidepressants and did not receive MBCT. Data from all 1,258 participants showed that MBCT reduced a person’s risk of depressive relapse over a 60 week period by approximately 31 per cent.
That study was part of an ongoing programme of work to explore MBCT for recurrent depression. Over the past few years this research, including earlier MRC-funded work led by Professor Willem Kuyken and other researchers around the world, led to MBCT being included by NICE as part of the recommended treatment guidelines for relapse prevention in depression.
So, current research tells us that MBCT is a useful intervention for people with recurrent depression. What we need to know now is: when does it work and why does it work?
The what and the why
Knowing what it is about MBCT that works in the context of recurrent depression – and why – will help us to predict who it will work for. This is important because we might find out that MBCT is particularly helpful for recurrently depressed patients with certain characteristics, and not for others.
In our team, we’re investigating whether there are any psychological or biological characteristics that make people with a history of depression more likely to benefit from MBCT. By identifying what psychological and biological changes occur when people learn to relate differently to their thoughts, we want to see whether it is possible to spot early signs of these changes when people begin treatment. Specific changes might indicate whether the treatment is likely to be helpful.
There is promising evidence that MBCT alters the neural circuits in our brain which help us process emotion and information about ourselves. We are currently preparing a study involving functional magnetic resonance imaging – a type of brain scan – where we will investigate what happens in the brain if someone has a history of suicidal depression and learns to relate differently to their depressive and suicidal thoughts. This could help us to identify a ‘biomarker’ – a way of measuring relevant change – so that we can tell as early as possible whether treatment is having an effect.
There are challenges ahead, for example most of the data we have is from Caucasian women so we don’t yet know if the results would apply to other groups. But if we can identify individuals who may benefit from MBCT, and monitor whether treatment is having a positive effect, we will maximise the benefits for those individuals most likely to respond and help them stay well.