Looking East: can meditation help the West to give up antidepressant drugs?

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Looking East: can meditation help the West to give up antidepressant drugs?

Every year millions of people around the world have depression and take pills. There are problems with more and more sales of medical drugs. Mischa Wilmers asks researchers about a very old Buddhist practice called mindfulness meditation. Is it a safer, better way to help depression?

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Impaulsive Photography under a Creative Commons Licence

Over the last ten years in the West there has been a very big problem with mental health. More and more people have depression. Charities tell us that in one year one in four people will have a mental health problem. Most people think that the stress of modern life is the reason. People say the reasons are more unemployment, more debt, relationship problems, and the economic problems in the world.

Chris Dowrick is the Professor of Primary Medical Care at the University of Liverpool, He wrote a report in the British Medical Journal (BMJ) in December 2013. He thinks that this is not the full story.. He says more people are told they have depression because we now see unhappiness as an illness.

In his report he writes that in the US 11 per cent of people over the age of 11 take antidepressants. In Britain not so many people take antidepressants. But people think that five million people now have depression. This is 200% more than in 2002. And doctors gave 200% more prescriptions for antidepressants between 1998 and 2010.

One possible reason is pressure from the drugs industry. The Diagnostics Manual (DSM IV and DSM V) includes forms of sadness which are usual in everyday life when family members die or there are money problems.

Dowrick explains that if somebody has lost a loved one and they have a kind of depression for more than two weeks, then a doctor can say they have real depression. Then very often doctors give pills.

Dowrick says that it is not a good idea to see unhappiness as an illness and pills are unlikely to help.

Drugs are no better than a placebo (something which helps because we think it will help)

Research shows that bestselling drugs like Prozac are no better than a placebo. Dowrick says that research shows clearly that antidepressants do not help mild depression. Antidepressants only help serious depression. Dowrick thinks we should think about therapies which do not have bad side-effects. He says mindfulness meditation can help.

Mindfulness comes from the teachings of the Buddha. The Buddha lived in India in the 4th century BC. The Buddha taught his students that it is important to live in the moment. Meditation helps with this. There are many different kinds of mindfulness meditation. Most meditations try to train the mind to concentrate on one thing – often the breathing.

At first it may seem strange that Western medicine should look for help to a 2,500-year-old Eastern tradition. But Professor Dowrick is not the first scientist to be interested in meditation.

At the University of Toronto, Professor of Psychiatry Zindel Segal has researched mindfulness meditation to help patients with depression for over ten years.

Professor Segal was first interested in meditation in 2000. He was given money by the Macarthur Foundation to find a new way to help depression. His idea was to work with Cognitive Behavioural Therapy (CBT). Cognitive Behavioural Therapy is a talk therapy with a psychiatrist and a patient. He wanted to find a way to stop the risk of patients becoming depressed again. He used the money to get the help of two colleagues, John Teasdale and Mark Williams from Oxford University. They had done research into depression. The three scientists found the work of Jon Kabat-Zinn. He had created a programme in the US for patients with bad pain. His Mindfulness Based Stress Reduction (MBSR) used simple breathing meditation to help patients. The patients were given audio tapes to practise meditation at home.

MBSR showed good results and Segal and the team thought meditation might help patients with depression. ‘We spent time with Jon Kabat-Zinn and his group, watching their teachers teach this material in MBSR. So at a personal level we felt there was something here that could be useful if we could help our depressed patients do the same thing,’ he explains. And so they put CBT with MBSR from Kabat-Zinn and made Mindfulness Based Cognitive Therapy (MBCT). Then it was time to see if it worked.

An important step forward

All the patients in MBCT’s first clinical trial had depression and 80 per cent had had depression three or more times. None were taking antidepressants at the time of the trial. The results showed an important step forward. MBCT did not help patients who had depression one or two. Patients who had depression three or more times showed a 34-36 per cent reduction in getting depression again in one year period compared to usual care. This was similar to what other studies had found for the use of antidepressants.

Other trials conducted at Cambridge University and the Oxford Mindfulness Centre (part of Oxford’s Department of Psychiatry) showed the same results.

Segal said they were very happy because they weren’t trying to do better than antidepressant drugs. They were happy with the same results as some drugs because they knew that many people who start drugs will not continue if they’re feeling better. They also knew that drug treatments have side effects that people find very difficult.

The results of MBCT are now so good that the National Institute for Clinical Excellence (NICE) recommends it and the therapy has been free on the NHS to a some patients in Britain since 2004.

Segal doesn’t believe MBCT should replace drugs altogether. He would like MBCT to be used with antidepressant drugs. MBCT, he says is not for patients who are in the middle of bad depression. It is to stop patients getting depression again. His research does not show if meditation can, as Professor Dowrick hopes, help people with mild depression. Before, doctors and scientists have been unsure if mindfulness meditation helps depression at all. Now the results are clearer than before.

Being clear

Dr Madhav Goyal works with medical researchers at John Hopkins University in Baltimore. He looked at more than 19,000 studies on meditation. Segal’s trial was one of 47 that were good enough to be in study collecting information on the different effects of meditation He said that most trials looked at patients with mild depression. Segal’s trial was one of the ones that looked at patients with serious depression. Goyal says that they didn’t want the studies that didn’t include placebo effects and that’s why we see a small number of trials in our study.

Perhaps it is disappointing that these results showed mindfulness meditation had little or no effect for most problems. But when the researchers looked at depression they found evidence of a 10-20 per cent improvement in mild depression in an average of eight weeks. These results were similar to those for antidepressants, and mindfulness meditation was also the only kind of meditation to show positive effects.

Mindfulness meditation didn’t do better than CBT and exercise. So how good were these results and what did scientists learn about the relationship between mindfulness and depression? Dr Goyal says that the results are so mixed that doctors weren’t sure if this was something that was helpful or just a placebo effect. Their study helps to make this clearer. We’re seeing that mindfulness meditation helps depression.

Professor Segal suggests that MBCT may still show advantages over other drug-free therapies. Firstly, mindfulness meditation in groups is probably cheaper than talk therapies like CBT, which are usually with one patient and one doctor.

This should make MBCT easier for patients to have in countries without free healthcare like the US and for patients who can’t afford a personal doctor. Segal also thinks that people who learn mindfulness meditation may be better than CBT patients over longer periods of time He says this is only an idea because very few studies have followed patients for more than a year after finishing therapy.

Most of the scientists involved in mindfulness research want it to be a more part of healthcare. The research is good but more studies are needed. There is a problem with finding money for the research. This is a problem after what Dowrick said about his worries with drugs.

Dowrick says that in medicine we don’t wait for excellent results for every therapy that we use. So some positive results are very good. It’s telling us that we didn’t find any bad side effects. We’re sure that this is going to be helpful and so that’s a good place to start.

As a GP Professor Dowrick often recommends meditation to patients with depression. He says all treatments have a small effect. There’s nothing that works perfectly for everyone. He is happy to see more mindfulness meditation free on the NHS [National Health Service].

As this article has been simplified, the words, text structure and quotes may have been changed. For the original, please see:http://newint.org/features/web-exclusive/2014/03/07/mindfulness-meditation-helps-treat-depression/