Evidence map›Paper›PMID 33177138›Full record

ArticleBMJ open2020

Discontinuing antidepressant medication after mindfulness-based cognitive therapy: a mixed-methods study exploring predictors and outcomes of different discontinuation trajectories, and its facilitators and barriers.

Marloes J Huijbers, Carolien Wentink, Esther Simons, Jan Spijker, Anne Speckens

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00928980 (The Clinical and Cost-effectiveness of Mindfulness Based Cognitive Therapy, Maintenance Antidepressant Medication and Its Combination in the Prevention of Relapse in Patients With Recurrent Depression), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00928980 nacompletednot on this map

The Clinical and Cost-effectiveness of Mindfulness Based Cognitive Therapy, Maintenance Antidepressant Medication and Its Combination in the Prevention of Relapse in Patients With Recurrent Depression

TypeinterventionalSponsorRadboud University Medical CenterRan2009 to 2013Enrolled317ConditionsDepressive Disorder, MajorArmsMindfulness Based Cognitive Therapy, Optimal Medical Care
3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Trial
  4. Acceptability and optimisation of resources to support antidepressant cessation: a qualitative think-aloud study with patients in Australian primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024
    Article
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  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Marloes J HuijbersPsychiatry, Radboudumc, Nijmegen, Gelderland, The Netherlands marloes.huijbers@radboudumc.nl.ORCID 0000-0002-3381-9691
Carolien WentinkPsychiatry, Radboudumc, Nijmegen, Gelderland, The Netherlands.
Esther SimonsPrimary and Community Care, Radboudumc, Nijmegen, The Netherlands.
Jan SpijkerExpertise Centre for Depression, Pro Persona Locatie Tarweweg, Nijmegen, Gelderland, The Netherlands.ORCID 0000-0003-1480-9647
Anne SpeckensPsychiatry, Radboudumc, Nijmegen, Gelderland, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThis study aimed to explore predictors and outcomes associated with different trajectories of discontinuing antidepressant medication (ADM), in recurrently depressed individuals after participation in mindfulness-based cognitive therapy (MBCT). Facilitators and barriers of discontinuation were explored qualitatively.

designMixed-methods study combining quantitative and qualitative data, drawn from a randomised controlled trial.

settingTwelve secondary and tertiary psychiatric outpatient clinics in the Netherlands.

participantsRecurrently depressed individuals (N=226) who had been using ADM for at least 6 months and in partial or full remission. Regardless of trial condition, we made

interventionsAll participants were offered MBCT, which consisted of eight weekly sessions in a group. PRIMARY AND SECONDARY OUTCOME MEASURES: Demographic and clinical predictors of successful discontinuation within 6 months, relapse risk within 15 months associated with different discontinuation trajectories, and barriers and facilitators of discontinuation.

resultsOf the 128 patients assigned to MBCT with discontinuation, only 68 (53%) fully discontinued ADM within 6 months, and 17 (13%) discontinued partially. Predictors of full discontinuation were female sex, being employed and lower levels of depression. Relapse risk was lower after no discontinuation (45%) or partial discontinuation (38%), compared with full discontinuation (66%) (p=0.02). Facilitators and barriers of discontinuation were clustered within five themes: (1) pre-existing beliefs about depression, medication and tapering; (2) current experience with ADM; (3) life circumstances; (4) clinical support and (5) mindfulness.

conclusionsDiscontinuing antidepressants appears to be difficult, stressing the need to support patients and physicians in this process. MBCT may offer one of these forms of support. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT00928980); post-results.

Indexed as

Cognitive Behavioral TherapyMindfulnessAdultAgedAntidepressive AgentsFemaleHumansMajor Depressive DisorderMaleMiddle AgedNeoplasm Recurrence, LocalNetherlandsTreatment OutcomeAntidepressive Agentsantidepressantsbarriers and facilitatorsdiscontinuationmindfulness-based cognitive therapyrecurrent depression

Identifiers

PMID33177138
PMCPMC7661362

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.