Participants in Mindfulness-Based Cognitive Therapy (MBCT) who are also taking antidepressants often wonder whether they will be able to come off their meds once the program is over or, for some, before or as they begin the MBCT program. Sometimes therapists get asked about this directly during the initial intake interview, while at other times participants may adopt a ‘let’s wait and see if this program really helps me’ attitude before asking.
The truth is, you can’t really blame them. If you read the headlines about MBCT, they highlight prevention effects on par with antidepressants. You might even say that this is one of MBCT’s selling points when it comes to public perception. When you combine this with numerous surveys showing that people are uncomfortable staying on medication over the long term, the question becomes more urgent.
Evidence from the largest meta-analysis to date (N=1329) supports the view that discontinuing meds does not increase the risk of relapse for MBCT participants. One advantage of combining data across studies, as opposed to drawing conclusions based on individual studies, is that one can have greater confidence in the strength of the findings. Also, examining data from individuals whose data are pooled from many studies allows researchers to identify potential factors that moderate MBCT’s benefits.
By moderate, we mean identifying characteristics of individuals that indicate whether one approach is better than another for particular people. This is important because we know that when it comes to personal well-being, there are multiple factors that influence whether depression returns. For MBCT participants who are taking antidepressants, the number of past episodes, presence or absence of residual symptoms, trauma history, and the frequency of home practice all can impact clinical outcomes. These variables must equally be taken into account when a decision to remove a pre-existing treatment regimen--in this case antidepressant medication--is being considered.
Returning to our MBCT therapist wondering how best to respond to the question of ‘if I enroll in the program, will I be able to stop taking my antidepressant medication?’ our best advice is to redefine the context as one that is outside MBCT and inside the participant--prescribing physician dyad. Doing so doesn’t mean that coming off meds following MBCT is no longer an option, it just means that the decision must be fully informed by careful attention to the participant’s clinical and treatment history. It also resonates with the teaching point in the 7th session of Mindful Mood Balance for Professionals, namely, ‘How can I best take care of myself?’ and puts into practice the skill of that session of customizing a plan for wellness that will continue long after the MBCT class sessions have ended.