On 2015 May 20, James C Coyne commented:

The registration of this trial http://www.isrctn.com/ISRCTN26666654 clearly states the hypothesis that mindfulness-based cognitive therapy (MBCT) with support to taper/discontinue antidepressant medication is superior to maintenance antidepressant medication in preventing depression over 24 months. No rationale is given for anticipating the superiority of MBCT, but it clearly was not achieved in the present study in terms of any primary or secondary outcomes. Nonetheless, this article proclaims the finding of no differences as an achievement. The study has been widely publicized in the media as demonstrating that there are no differences between MBCT and antidepressants, which is clearly not a conclusion justified by the design or the results.

The claims of the present article require a noninferiority design which requires, in turn, a much larger sample size.

In a blog post http://blogs.plos.org/mindthebrain/2015/05/20/is-mindfulness-based-therapy-ready-for-rollout-to-prevent-relapse-and-recurrence-in-depression/, I detail a number of concerns about this study and suggest it does little to fill the gaps in what little we know about tapering depressed patients receiving antidepressants in primary care. The patients who were recruited to the study were judged by semi structured research diagnostic interviews to be in remission, but their status at the time of prescription of antidepressants is only reconstructed retrospectively. Primary-care physicians typically do not make decisions to prescribe antidepressants on the basis of a formal semi structured interview with symptom counts.

This article provides no report of the treatment received by patients assigned to the maintenance antidepressant group and what quality and quality of care they received or even their adherence at the start of the study. Some studies suggest that a substantial proportion of primary care patients are already nonadherent six months after their initial prescription of antidepressants.

NICE guidelines recommend maintenance therapy for two years, but these guidelines are based on experiences in tertiary specialty psychiatric populations where the course of depression may be more severe and the risk of relapse greater. Arguably, a descriptive observational study would’ve been less expensive and more informative if it assessed adherence, contact with providers, and symptoms and side effects of primary care patients who were prescribed antidepressants a year earlier.

Results of this study would be much more informative if there had been better description of the care received in the control group or, better, a comparison/control group that provided equivalent amounts of attention, contact time, and support. It could well be that a specialized depression care manager with less training could have achieved equivalent results. Moreover, we simply don’t know if physicians advising their remitted patients to taper antidepressants would have achieved the same results.

On 2015 May 20, James C Coyne commented:

The registration of this trial http://www.isrctn.com/ISRCTN26666654 clearly states the hypothesis that mindfulness-based cognitive therapy (MBCT) with support to taper/discontinue antidepressant medication is superior to maintenance antidepressant medication in preventing depression over 24 months. No rationale is given for anticipating the superiority of MBCT, but it clearly was not achieved in the present study in terms of any primary or secondary outcomes. Nonetheless, this article proclaims the finding of no differences as an achievement. The study has been widely publicized in the media as demonstrating that there are no differences between MBCT and antidepressants, which is clearly not a conclusion justified by the design or the results.

The claims of the present article require a noninferiority design which requires, in turn, a much larger sample size.

In a blog post http://blogs.plos.org/mindthebrain/2015/05/20/is-mindfulness-based-therapy-ready-for-rollout-to-prevent-relapse-and-recurrence-in-depression/, I detail a number of concerns about this study and suggest it does little to fill the gaps in what little we know about tapering depressed patients receiving antidepressants in primary care. The patients who were recruited to the study were judged by semi structured research diagnostic interviews to be in remission, but their status at the time of prescription of antidepressants is only reconstructed retrospectively. Primary-care physicians typically do not make decisions to prescribe antidepressants on the basis of a formal semi structured interview with symptom counts.

This article provides no report of the treatment received by patients assigned to the maintenance antidepressant group and what quality and quality of care they received or even their adherence at the start of the study. Some studies suggest that a substantial proportion of primary care patients are already nonadherent six months after their initial prescription of antidepressants.

NICE guidelines recommend maintenance therapy for two years, but these guidelines are based on experiences in tertiary specialty psychiatric populations where the course of depression may be more severe and the risk of relapse greater. Arguably, a descriptive observational study would’ve been less expensive and more informative if it assessed adherence, contact with providers, and symptoms and side effects of primary care patients who were prescribed antidepressants a year earlier.

Results of this study would be much more informative if there had been better description of the care received in the control group or, better, a comparison/control group that provided equivalent amounts of attention, contact time, and support. It could well be that a specialized depression care manager with less training could have achieved equivalent results. Moreover, we simply don’t know if physicians advising their remitted patients to taper antidepressants would have achieved the same results.