Meditation not medication for depression

6th December 2010 - A report for The Mental Health Foundation says many patients with recurrent depression are not getting access to therapies like meditation.

Mindfulness Based Cognitive Therapy (MBCT) was recommended for people who suffer repeated bouts of depression by the National Institute for Health and Clinical Excellence in 2004. However, the report called ‘Be Mindful’ says that, five years later, only one in five GPs say they can get the treatment for their patients, and only one in 20 prescribe it regularly.

Depression facts

The Mental Health Foundation says depression affects one in 10 people and costs the economy £7.5 billion a year.

The number of prescriptions made each year for antidepressants in England has doubled in a decade to 36 million in 2008.

Mindfulness based cognitive therapy benefits

MBCT has been shown to cut relapse rates by 50% for those who experience more than two episodes of depression. The Mental Health Foundation says recurrent depression is common, with half of sufferers having more than one episode.

The charity is calling for the NICE guidelines to be fully implemented so that all patients with recurrent depression are offered MBCT.

The therapy programme involves an eight week course in meditation with elements of cognitive behavioural therapy and yoga.

The Mental Health Foundation is making more information available about MBCT, including details of local courses, on a special website.

The website information says “Mindfulness helps people change the way they think, feel and act. It helps them to break free from a downward spiral of negative thought and action, and make positive choices that support their wellbeing.”

The role of GPs

The Be Mindful survey showed:

• 72% of GPs think it would be helpful for their patients with mental health problems to learn mindfulness meditation skills
• 69% of GPs say they rarely - or never - refer their patients with recurrent depression to MBCT; 5% refer to it very often. However, 47% say they very often prescribe antidepressants
• Three-quarters (75%) of GPs have prescribed antidepressants to patients with recurrent depression, believing that an alternative approach might have been more appropriate
• Two-thirds (67%) did so because there was a waiting list for the suitable alternative treatment, 57% because they didn’t have sufficient access to other suitable treatments, and 50% because it was the treatment option preferred by the patient
• 20% of GPs say they have access to MBCT courses for their patients; 48% say they do not, and 32% don’t know if they have access or not

Antidepressants less effective for less severe depression

The Be Mindful report coincides with a US study which suggests that antidepressants are most effective among people who are severely depressed when they start taking them, but less so among people only mildly or moderately depressed.

University of Pennsylvania researchers looked at the results of six previously published studies that compared the effects of antidepressants versus placebo for more than 700 adults with varying levels of depression. Their work is published in the Journal of the American Medical Association.

Only two anti-depressants were included. Three of the studies looked at paroxetine, an SSRI (selective serotonin reuptake inhibitor) and the others looked at imipramine, an older tricyclic anti-depressant.

''The main finding is that the benefit of medication, over and above the placebo, varied as a function of the severity of the depression," says study author Jay Fournier. "The effect of the medication for the mild, moderate and even severe fell below this three-point difference that would be clinically significant." The analysis suggests that some depressed people do also respond to a placebo, he says.