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

Autor: Huijbers MJ; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands., Wentink C; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands., Lucassen PLBJ; Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands., Kramers C; Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands.; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands., Akkermans R; Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.; IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands., Spijker J; Expertise Centre for Depression, Pro Persona Nijmegen, Nijmegen, The Netherlands., Speckens AEM; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Sep 05; Vol. 18 (9), pp. e0290965. Date of Electronic Publication: 2023 Sep 05 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0290965
Abstrakt: Discontinuing antidepressant medication (ADM) can be challenging for patients and clinicians. 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 discontinuing (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 significant 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).
Competing Interests: Marloes Huijbers and Anne Speckens were employed by the Radboud Centre for Mindfulness and work as mindfulness teachers. Carolien Wentink was employed by the Radboud Centre for Mindfulness during the conduct of the trial. They reported no financial or other conflicts of interest. All other authors reported no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2023 Huijbers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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