The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study)

BACKGROUND TO THE RESEARCH. Depression is an extremely common and disabling mental health problem that is most commonly treated in the NHS with antidepressant drugs. Even though antidepressant drugs help many people with depression get well, the rates of people getting depressed again are very high. Also, service users often express a wish for psychological help that can help them recover from depression in the long-term. We need to develop psychological therapies that prevent depression coming back repeatedly that will be easy for service users to access in the NHS. A recently developed treatment, Mindfulness-based Cognitive Therapy (shortened to MBCT, see www. mbct.co.uk) shows potential as a brief group programme for people with recurring depression. In two studies it has been shown to halve the rates of depression recurring compared to normal NHS treatment. Mindfulness-based Cognitive Therapy is a therapy for people who have experienced a lot of depression and works by helping people to learn skills that can prevent depression coming back. People learn these skills in eight weekly two hour classes of up to 15 people who have had similar experiences. Patients say that they find the treatment accessible and helpful. OUR RESEARCH QUESTIONS. We would like to find out how well MBCT works compared with the current treatment of choice (anti-depressants drugs) within a standard NHS setting. We also want to find out how it works. OUR RESEARCH METHODS. This study will be set in real world NHS primary care settings and will recruit people with a history of recurrent depression who are interested in a psychological approach to staying well in the long-term. The study involves a number of stages: (1) an initial getting to know participants' in terms of their current and past mental health, (2) allocation to one of two therapies for recurring depression (staying on anti-depressants and MBCT) and (3) seeing how participants are doing at regular intervals over 24 months. In the MBCT groups, once patients have learned coping skills they will be invited to discuss with the GP tapering and discontinuing their anti-depressant medication. To see if MBCT offers an alternative to staying on antidepressants long-term we will see if the patients who participate in MBCT stay as well as those who receive ongoing antidepressant treatment. The regular follow ups will ask: have people stayed well, how is their quality of life, how are they functioning, are they continuing to take antidepressants and what services are they using? We have included a broader set of outcomes because they are valued by service users. To find out how MBCT works we will ask people about their experiences of MBCT and assess the things we think MBCT changes (e.g., coping skills to prevent depression returning) before and after treatment.