Use of mindfulness during antidepressant withdrawal trial

[Vonnegutjunky]

 PLoS ONE 18(9): e0290965. https://doi. org/10.1371/journal.pone.0290965
Editor: Jan Christopher Cwik, University of Cologne: Universitat zu Koln, GERMANY
Received: April 3, 2022 Accepted: August 17, 2023 Published: September 5, 202

 

Supporting antidepressant discontinuation using mindfulness plus monitoring versus monitoring alone: A cluster randomized trial in general practice 

 

Marloes J. Huijbers1*, Carolien Wentink1, Peter L.B.J. Lucassen2, Cornelis Kramers3,4, Reinier Akkermans2,5, Jan Spijker6, Anne E.M. Speckens1

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0290965

 

Discontinuing antidepressant medication (ADM) can be challenging for patients and clini- cians. In the current study we investigated if Mindfulness-Based Cognitive Therapy (MBCT) added to supported protocolized discontinuation (SPD) is more effective than SPD alone to help patients discontinue ADM. This study describes a prospective, cluster-randomized controlled trial (completed). From 151 invited primary care practices in the Netherlands, 36 (24%) were willing to participate and randomly allocated to SPD+MBCT (k = 20) or SPD (k = 16). Adults using ADM > 9 months were invited by GPs to discuss tapering, followed by either MBCT+SPD, or SPD alone. Exclusion criteria included current psychiatric treatment; substance use disorder; non-psychiatric indication for ADM; attended MBCT within past 5 years; cognitive barriers. From the approximately 3000 invited patients, 276 responded, 119 participated in the interventions and 92 completed all assessments. All patients were offered a decision aid and a personalized tapering schedule (with GP). MBCT consisted of eight group sessions of 2.5 hours and one full day of practice. SPD was optional and consisted of consultations with a mental health assistant. Patients were assessed at baseline and 6, 9 and 12 months follow-up, non-blinded. In line with our protocol, primary outcome was full discontinuation of ADM within 6 months. Secondary outcomes were depression, anxiety, withdrawal symptoms, rumination, well-being, mindfulness skills, and self-compassion. Patients allocated to SPD + MBCT (n = 73) were not significantly more successful in discon- tinuing (44%) than those allocated to SPD (n = 46; 33%), OR 1.60, 95% CI 0.73 to 3.49, p = .24, number needed to treat = 9. Only 20/73 allocated to MBCT (27%) completed MBCT. No serious adverse events were reported. In conclusion, we were unable to demonstrate a sig- nificant benefit of adding MBCT to SPD to support discontinuation in general practice. Actual participation in patient-tailored interventions was low, both for practices and for patients. (Trial registration: ClinicalTrials.gov PRS ID: NCT03361514 registered December 2017)

 

[manymoretodays]

On 3/30/2024 at 1:11 AM, Vonnegutjunky said:

In line with our protocol, primary outcome was full discontinuation of ADM within 6 months. Secondary outcomes were depression, anxiety, withdrawal symptoms, rumination, well-being, mindfulness skills, and self-compassion. Patients allocated to SPD + MBCT (n = 73) were not significantly more successful in discon- tinuing (44%) than those allocated to SPD (n = 46; 33%), OR 1.60, 95% CI 0.73 to 3.49, p = .24, number needed to treat = 9. Only 20/73 allocated to MBCT (27%) completed MBCT. No serious adverse events were reported. In conclusion, we were unable to demonstrate a sig- nificant benefit of adding MBCT to SPD to support discontinuation in general practice. Actual participation in patient-tailored interventions was low, both for practices and for patients.

 

Interesting. 

I have to think that the primary outcome of discontinuation over 6 months for all, wasn't good.  As we know, sometimes years is much better, as well as adjusting accordingly the taper schedule and amount.

Obviously the participants just weren't into the Mindfulness Based Cognitive Therapy.

And I liked that self compassion was included in secondary outcomes.

 

Thanks for posting Vonnegutjunky.  Good job!

 

I wouldn't let it deter anyone from utilizing mindfulness based cognitive therapy or whatever else, non-drug/pharmaceutical methods they might find beneficial to cope.