Difficult-to-treat depression is more than a clinical hurdle. It can be a matter of life and death. Research already established that treatment-resistant patients have “a 17% higher overall mortality rate, with nearly double the risk of suicide, and a 27% higher risk of accidental death.”
But new data offers a glimmer of hope for those battling depression but aren’t responding well to standard treatment.
A group of researchers have published a paper that shows that Mindfulness-Based Cognitive Therapy (MBCT) dramatically curbs symptoms of anxiety and depression in these individuals. It’s a new lifeline, the authors contend, that offers both clinical and economic benefits that could transform how the United Kingdom’s National Health Service (NHS) approaches treatment.
“For most people with severe depression, it’s more than a condition,” explained Mary Ryan, a patient adviser and co-author of the study. “It’s a recurring part of their life story. Up to now, people have often been told that they’ve reached the end of the road for psychological treatment, that there are no other options for them. The findings of this trial are hugely important because we’re telling this group of people that they still matter – that there’s something else we can try that may work for them.”
Depression Treatment Failures Prompts Research
Depression remains one of the most burdensome mental health conditions globally, and treatment resistance is all too common. Nearly half of the patients with depression who complete high-intensity psychological therapy in the UK’s NHS Talking Therapies program fail to secure remission.
Today, most of these individuals are discharged without further treatment, despite showing continued clinical symptoms. The National Institute for Health and Care Excellence (NICE) has identified the lack of established follow-up care as a perilous research and treatment gap.
This new research is the first of its kind to evaluate both the long-term clinical effectiveness and cost-effectiveness of MBCT for individuals who haven’t achieved remission after traditional psychological therapy. MBCT, an eight-week group intervention delivered via videoconferencing, teaches mindfulness practices to help patients disengage from persistent negative thinking patterns.
Originally developed to stave off relapse in patients with recurrent depression, MBCT has started to show promise as a secondary treatment approach for difficult-to-treat depression.
Promising Results
In this randomized controlled trial, researchers compared outcomes for participants who received MBCT along with the usual care against those who just received the traditional treatment.
The results showed that MBCT led to small-to-moderate improvements in depressive symptoms that persisted at least six months after treatment. Moreover, participants also experienced improvements in general wellbeing and reductions in anxiety symptoms, although gains in anxiety were more modest.
“We are highly encouraged by our findings, which reveal that MBCT treatment offers a powerful dual benefit for this group: superior patient outcomes coupled with notable cost savings for the NHS,” study co-author Barbara Barret, health economics professor at King’s College London, said.
But it wasn’t just that MBCT appeared to be clinically effective. It also offered economic advantages. Patients receiving the therapy took advantage of fewer healthcare services overall, which meant a net drop in costs. The intervention also achieved cost-effectiveness thresholds far below NICE requirements.
Most of the study participants arrived with complex mental health histories, with early-onset depression, frequent relapses, and multiple comorbidities. Many were also taking antidepressants, suggesting that MBCT worked well even among a population with a host of previous treatment failures.
Ultimately, the estimated difference in sustained remission between the MBCT group and control group – roughly 12% – lines up with earlier, similar studies.
Authors Urge Broader Adoption
“For vulnerable people with depression, MBCT is particularly helpful for a number of reasons,” Clara Strauss, Professor of Clinical Psychology at the University of Sussex, said. “It helps people to recognise negative, self-critical thoughts as thoughts, rather than as facts and so helps to lessen their emotional impact. It helps people to be more accepting of their difficult experiences and to be kinder to themselves. MBCT also helps people to avoid getting stuck in unhelpful, repeated cycles of negative thinking. Encouragingly, our trial shows MBCT can even work for people where other forms of talking therapy have had little effect.”
The study builds on earlier research showing that MBCT can help those who don’t respond to traditional pharmacological treatments. Until now, though, no trial managed to assess its impact following failed psychological therapy. The results of this study, then, strengthen the argument that NICE guidelines could (and should) endorse MBCT as a recommended follow-up protocol for hard-to-treat patients.
The study’s authors insist that the evidence is clear: MBCT is both an effective and financially viable intervention that should be an available option to patients who still struggle after conventional therapy. A wider rollout could transform how we manage persistent depression and alleviate the pressure on strained mental health services.
Further Reading
Esketamine Nasal Spray Offers Help for Treatment-Resistant Depression
Effects of Low-Dose Ketamine Infusion on Hopelessness and Suicidal Thoughts
Study Highlights Increased Mortality Risks in Difficult-to-Treat Depression
