Preventing Relapse in Depression: the Mindfulness-Based Cognitive Therapy and Medication Alliance Therapy Project.

INTERVENTION: Participants will receive Mindfulness‐Based Cognitive Therapy (MBCT) and Medication Alliance Technology (MAT), singly and in combination. The overall aim of this project is to establish and trial the methodology for a thorough investigation of the efficacy of two therapeutic interventions, Mindfulness‐Based Cognitive Therapy (MBCT) and Medication Alliance Technology (MAT), singly and in combination, in the prevention of depressive relapse in people who have had at least two previous episodes of depression. This project is a complex study design (2x2 factorial) in which these two different treatments are delivered singly and in combination, and are compared against a treatment as usual control group. The duration of the intervention is 14 months from randomisation to the different treatment conditions. This includes administration of 5 follow up questionnaires. CONDITION: Recurrent depression PRIMARY OUTCOME: 1/.Reduction in depressive relapse. ; Key outcome variables and measures will include: ; ‐ rates of relapse and recurrence (defined as re‐emergence of major depressive disorder according to DSM IV criteria as assessed by the Composite International Diagnostic Interview; ; ‐ the full CIDI will be used on entry to the project ; at follow‐up administrations, the CIDI short form and the depressive disorders module will be administered; ; ‐ time to relapse (measured as above); ; ‐ mean depressive symptom ratings at followup points (assessed by the Hamilton Rating Scale for Depression; and the Beck Depression Inventory; ; ‐ disability / role functioning (assessed by the Work and Social Adjustment Scale; quality of life (assessed by the Australian Quality of Life measure; life satisfaction (taken from the International Wellbeing Index). 2/.To establish and trial the methodology for a thorough investigation of the efficacy of two therapeutic interventions, MBCT and MAT, singly and in combination, in the prevention of depressive relapse in people who have had at least three previous episodes of depression. ; Key outcome variables and measures will include: ; ‐ rates of relapse and recurrence (defined as re‐emergence of major depressive disorder according to DSM IV criteria as assessed by the Composite International Diagnostic Interview; ; ‐ the full CIDI will be used on entry to the project ; at follow‐up administrations, the CIDI short form and the depressive disorders module will be administered; ; ‐ time to relapse (measured as above); ; ‐ mean depressive symptom ratings at followup points (assessed by the Hamilton Rating Scale for Depression; and the Beck Depression Inventory; ; ‐ disability / role functioning (assessed by the Work and Social Adjustment Scale; quality of life (assessed by the Australian Quality of Life measure; life satisfaction (taken from the International Wellbeing Index). SECONDARY OUTCOME: Efficacy of MAT in reducing depressive relapse is mediated by an increase in adherence. Efficacy of MBCT in reducing depressive relapse is mediated by an increase in mindfulness. Participants receiving MAT will demonstrate greater adherence to prescribed medication and attendance at scheduled appointments than others. Participants receiving MBCT and MAT in combination will be less likely to experience depressive relapse within 12 months than participants receiving either one of these interventions alone. Participants receiving MBCT and/or MAT will be less likely to experience depressive relapse within 12 months than those who receive usual clinical management INCLUSION CRITERIA: Prescribed antidepressant medication or not;Ability to speak and read English fluently;Meeting DSM‐IV TR criteria for three previous major depressive episodes; at least two of which must have occurred within the past five years, and one within the past two years.At assessment, score on the Hamilton Rating Scale for Depression of less than 10.At assessment, score with respect to antidepressant medication on the Adherence Scale of 5 or less.