Relação entre a Mindfulness-Based Cognitive Therapy e seu efeito no transtorno depressivo maior

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução: MBCT práticas aumenta a capacidade de concentração e de atenção, assim é particularmente eficaz para as pessoas com depressão recorrente e resistentes ao tratamento.

Objetivo: analisar os efeitos da aplicação da MBCT nos sintomas do Transtorno Depressivo Maior (TDM).

Metódos: Revisão sistemática e metanálise. Utilizou-se para a busca dos estudos, a base de dados MEDLINE (PubMed), com os descritores mindfulness e major depressive disorder. Selecionaram-se artigos na língua inglesa entre os anos de 2003 a 2015. Os estudos foram avaliados quanto sua qualidade metodológica pela escala Pedro (pontuação maior que 3), que demonstrassem evidência empírica, com design de estudo experimental (randomizado e não randomizado) e estar disponível na íntegra. Para a metanálise utilizou-se modelo de efeitos aleatórios com diferenças médias padronizadas e intervalos de confiança de 95%.

Resultados: Quatorze estudos foram incluídos, sendo 03 não randomizados, contendo apenas um grupo de intervenção da MBCT e 11 estudos randomizados, divididos em amostras de dois grupos e amostras de três grupos. Os estudos não randomizados apresentaram escala Pedro de 5 pontos, os randomizados de dois grupos (de 5 a 10 pontos) e de três grupos (de 6 a 9 pontos). Na metanálise os quatro 4 estudos randomizados selecionados, revelaram um efeito moderado da MBCT sobre o desfecho dos sintomas da depressão, com uma diferença média de -0.52 (IC 95%: -1.050 a -0.002; p = 0.04).

Conclusão: A MBCT apresenta-se como uma alternativa promissora para tratamento desse transtorno.

Palavras-Chave:
Meditação; Depressão; Terapia Comportamental; Transtorno Depressivo Maior

Studies	Years	Studies Local	Questionnaire	Journals
Finucane e Merce³²	2006	Ayrshire, Scotland University of Glasgow (EUA)	BDI-II, BAI	BMC Psychiatry
Kenny e Willians³³	2007	Queen Elizabeth Hospital (UK)	BDI	Behaviour Research and Therapy
Barnhofer et al.³⁴⁾	2009	Department of Psychiatry, Warneford Hospital (UK)	BDI-II; BSS	Behaviour Research and Therapy
Bondolfi et al.³⁵	2010	Geneva e Lausanne University Hospitals (Suíça)	MADRS; HAM-D 17	Journal of Affective Disorders
Segal et al.³⁶	2010	Centre for Addiction and Mental Health (CAMH), Toronto and St. Joseph’s Healthcare, Hamilton	HAM-D 17	Arch Gen Psychiatry
Bieling et al.⁴²	2012	Centre for Addiction and Mental Health (CAMH), Toronto and St. Joseph's Healthcare, Hamilton	HRSD	Journal of Consulting and Clinical Psychology
Van Vugt et al.²⁾	2012	Department of Psychology in Tucson, University of Arizona. (EUA)	BDI; STAI-Y1, RSQ; TSST	Frontiers in Human Neuroscience
Batink et al.⁴³	2013	Maastricht (Holanda)	HRSD; RSS	PLoS One
Munshi et al.³⁷	2013	Langley Porter Psychiatric Hospital and Clinics (LPPH&C) at the University of California San Francisco (EUA)	BDI-II; RRS; STAI-Y1	Mindfulness
Omidi et al.³⁸	2013	Social Welfare and Rehabilitation Sciences and Tehran University Counseling Centre (Irã)	BSI	Iran Red Crescent Med Jornal
Schoenberg e Speckens³⁹	2014	Radboud University Medical Centre Nijmegen (Holanda)	IDS; RRS	Cogn Neurodyn
Williams et al.⁴⁰⁾	2014	Clinicas de saúde mental em Oxford, England, and Bangor, North Wales	BDI-II; Suicide Attempt and Self-Injury Interview	Jornal of Consuling and Clinical Psychology
Kuyken et al.⁴¹	2015	Quatro centros de UK: Bristol, Exeter and east Devon, north and mid Devon, and south Devon	BDI	Lancet
Shallcross et al.¹³	2015	Àrea urbana de Rocky Mountain West (EUA)	BDI-II	Jornal of Consuling and Clinical Psychology

Author, year	Criteria Pedro scale	Subjects	Intervention	Findings
Finucane e Merce³²	5/11	13 individuals with MDD	GI - *MBCT	Depression BDII Mean (SD)
		(03 male, 10 female)		Baseline to 8-week = 35.73(8.69) to 17.82(14.59)
		(18 to 65 years old)		Anxiety BAI Mean (SD)
		(ICD-10)		Baseline to 8-week = 32.00(12.50) to 20.51(17.08)
Kenny e Willians³³	5/11	46 individuals with MDD	GI - *MBCT	BDI for suicidal Mean (SD)
		(20 male, 59 female)	- moderate (n=26) (BDI ≤ 24) and, severe (n=29) (BDI ≥ 25)	- With thoughts of death and suicide = Baseline to 8-week = 27.2(10.6) to 14.8(10.6)
		(17 to 61 years old)	- With and Without thoughts of death and suicide	- Without thoughts of death and suicide = Baseline to 8-week = 20.2(5.7) to 12.8(7.8)
		(DSM-IV - SCID)	- Homework involved around 1 h per day of meditation or yoga, and other related formal and informal practices for the 8 weeks	Depression BDI Mean (SD) p
		(patients who were currently actively depressed, and who had not responded fully to standard treatments)		- moderate (BDI ≤ 24) = Baseline to 8-week = 17.2(4.3) to 11.5(7.8)
				- severe (BDI ≥ 25) = Baseline to 8-week = 33.2(6.4) to 17.1(11.2)
				Total = Baseline to 8-week = 24.39(9.8) to 13.9(9.7) p.00
Barnhofer et al.³⁴	5/11	28 individuals with MDD	GI - (14) *MBCT	Depression BDII Mean (SD) p
		(19 female, 9 male)	GII - (14) TAU	MBCT - Baseline to 8-week = 29.36(9.66) to 17.62(10.94) p.00
		(18 to 65 years old)		TAU - Baseline to 8-week = 31.32(10.79) to 28.86(12.97) ns
		(DSM-IV - SCID)		Suicide Ideation BSS Mean (SD)
				MBCT - Baseline to 8-week = 2.21(2.45) to 1.14(1.79)
				TAU - Baseline to 8-week = 2.78(2.08) to 2.42(2.53)
				Group did not meet criteria for a full episode of Major Depression at post-assessment
				MBCT - 70%
				TAU - 18%
Bondolfi et al.³⁵	8/11	55 individuals with MDD	GI - (27) *MBCT + TAU	Antidepressant medication was reinstated in
		(43 female, 12 male)	GII - (28) TAU	MBCT+TAU - 36%
		(18 to 65 years old)	Follow-up = 14 months	TAU- 31%
		(DSM-IV - SCID)		Time to relapse
		(limited the inclusion to patients with 3 or more previous episodes; least three past depressive episodes (2 episodes in the past 5 years and at least one in the past 2 years); remission for at least 3 months at time of enrolment; history of treatment with antidepressants but to currently be off medication for at least 3 months before enrolment)		MBCT+TAU - 29 weeks
				TAU - 10 weeks
				Delay until onset of antidepressant medication
				MBCT+TAU - 204 day
				TAU - 111 day
				One or more visit for counselling, psychotherapy or support from professional mental health staff was undertaken
				MBCT+TAU - 46%
				TAU - 55%
Segal et al.³⁶	9/11	84 individuals with MDD	GI - (28) m-ADM (To maintenance antidepressant medication)	Rate of relapse
		(48 female, 36 male)	GII - (26) *MBCT (To discontinuation antidepressant medication + MBCT)	M-ADM - 27%
		(18 to 65 years old);	GIII - (30) PLA (To discontinuation antidepressant medication + placebo and clinical management)	MBCT - 28%
		(DSM-IV - SCID)	(Patients in both the placebo and MBCT conditions had their medication tapered gradually, during a 4-week period, via placebo substitution and reduced pill count, respectively, at the recommended rate for their specific medication to minimize the risk of discontinuation syndrome)	PLA - 71%
		(disorder with a minimum of 2 past episodes and ≥ 16 Hamilton Rating Scale for Depression)	Follow-up = 18 months	Days to reach remission, mean (SD)
				M-ADM - 80.1(60.0)
				MBCT - 68.1(51.9)
				PLA - 90(57.8)
Bieling et al.⁴²	6/11	84 individuals with MDD	GI - (28) ADM (To maintenance antidepressant medication)	Rumination Mean (SD)
		(52 female, 32 male)	GII - (26) *MBCT (To discontinuation antidepressant medication + MBCT)	MBCT - Baseline to 8-week = 17.40(4.10) to 17.73(3.91) ns
		(18 to 65 years old)	GIII - (30) PLA (To discontinuation antidepressant medication + placebo)	ADM - Baseline to 8-week = 19.12(2.20) to 19.33(2.66) ns
		(DSM-IV)	Follow-up = 6 months	PLA - Baseline to 8-week = 19.12(2.83) to 19.05(3.36) ns
Van Vugt et al.²	9/11	45 individuals with MDD	GI - (19) control	Depression BDI Mean p
		(39 female, 06 male)	GII - (26) *MBCT	MBCT - Baseline to 8-week = 9.1 to 6.5 p.01
		(24 to 64 years old)		Positive words (%)
		(DSM-IV - SCID)		MBCT - Baseline to 8-week = 28.9 to 33.5
		To maintenance antidepressant medication		Control - Baseline to 8-week = 27.3 to 30.5
				Negative words (%)
				MBCT - Baseline to 8-week =27.2% to 27.4
				Control - Baseline to 8-week = 24.0 to 32.0
				Anxiety (STAI-Y1) Mean (SD)
				MBCT - Baseline to 8-week = 53.4(10.9) p/ 50.7 (11.12) p.05
Batink et al.⁴³	8/11	130 individuals with MDD	GI - (64) *MBCT + TAU	Rumination Mean (SD)
		(98 female, 32 male)	GII - (66) TAU	MBCT + TAU- Baseline to 8-week = ≤2 - 7.8(8.5) to - 8.1(8.4) ns
		(24 to 64 years old)	Randomization was stratified according to number of depressive episodes (≤2 MDE vs ≥3 MDE)	MBCT + TAU- Baseline to 8-week = ≤3 - 7.8(8.5) to - 7.5(8.8) ns
		(DSM-IV - SCID)		TAU - Baseline to 8-week = ≤2 -2.7(7.7) to - 1.9(6.9) ns
		To maintenance antidepressant medication		TAU - Baseline to 8-week = ≤3 -2.7(7.7) to - 3.7(8.6) ns
Munshi et al.³⁷⁾	5/11	18 individuals with MDD	GI - *MBCT	Depression (BDI) Mean p
		(13 female, 05 male)	Follow-up = 48.7 months	Baseline to 8-week to follow-up -18.78 to 5.33 to 5.89 p.00
		(24 to 81 years old)		Rumination (RRS) Mean
		(DSM-IV - SCID)		Baseline to 8-week to follow-up - 49.28 to 44.41 to 40.11 p.00
				Anxiety (STAI-Y1) Mean
				Baseline to 8-week to follow-up - 44.22 to 31.56 to 31.22 p.00
Omidi et al.³⁸	8/11	90 individuals with MDD	GI - (30) *MBCT	Depression (BSI) Mean (SD)
		(60 female, 30 male)	GII - (30) CBT (traditional Cognitive Behavior Therapy)	MBCT - Baseline to 8-week - 2.05(0.84) to 0.79(0.63)
		(18 to 45 years old)	GIII - (30) TAU	CBT - Baseline to 8-week - 2.18(0.57) to 0.79(0.51)
		(DSM-IV - SCID)		TAU - Baseline to 8-week - 2.18(0.85) to 1.96(0.86)
				Brief Symptom Inventory (BSI) Mean (SD)
				MBCT - Baseline to 8-week - 1.62(0.56) to 0.72(0.46)
				CBT - Baseline to 8-week - 1.79(0.47) to 0.72(0.26)
				TAU - Baseline to 8-week - 1.79(0.50) to 1.59(0.52)
Schoenberg e Speckens³⁹	7/11	51 individuals with MDD	GI - (25) control	Depression IDS Mean (SD)p
		(60 female, 30 male)	GII - (26) *MBCT	MBCT - Baseline to 8-week - 27.3(9.4) to 19.3(9.3) p.02
		(21 to 65 years old)		Control - Baseline to 8-week - 25.1(12.3) to 25.3(13.2) ns
		(DSM-IV-TR)		Response patterns towards feelings of sadness/depression (RRS) Mean (SD)p
				MBCT - Baseline to 8-week - 60.6(11.9) to 55.1(11.0) p.03
				Control - Baseline to 8-week - 60.2(13.2) to 59.7(13.8) ns
Williams et al.⁴⁰⁾	6/11	255 individuals with MDD	GI - (99) *MBCT	Relapse to Major Depression (%)
		(198 female, 57 male)	GII - (103) **CPE (cognitive psychological education)	MBCT - 46%
		(18 to 70 years old)	GIII - (53) TAU	CPE - 50%
		(DSM-IV - SCID and suicidal feelings and at least one other symptom of depression, which together were not attributable to bereavement, substances, or medical condition, but were impairing functioning)	Follow-up = 6 months	TAU - 53%
				Antidepressant use (%)
				MBCT - 18%
				CPE - 13%
				TAU -21%
				Looked for a psychiatrist (%)
				MBCT - 10%
				CPE - 9%
				TAU - 11%
Kuyken et al.⁴¹	10/11	424 individuals with MDD	GI = (212) *MBCT-TS = mindfulness + support to taper or discontinue their maintenance antidepressant medication	Depression BSII Mean (SD)
		(325 female, 99 male)	GII = (212) m-ADM	MBCT-TS
		(20 to 79 years old)	Follow-up = 24 months	Baseline 13.8(12.4) to 1 month 9.9(9.7) to 9 months 11·0 (10·5) to 12 months 10.7(10.0) to 18 months 11.7(10.6) to 24 months 11.6(10.9) ns
				m-ADM
				Baseline 14.4(10.1) to 1 month 13.9(10.9) to 9 months 10.5(9.7) to 12 months 11.3(9.2) to 18 months 11.3(10.7) to 24 months 11.9(10.7) ns
Shallcross et al.¹³	8/11	51 individuals with MDD	GI - (29) *MBCT	Depression BDII Mean (SD)
		(38 female, 13 male)	GII - (22) **ACC active control condition	MBCT
		(18 to 65 years old)	Follow-up = 12 months	Baseline 12.1(7.5) to 1 month 11.9(7.2) to 6 months 8.2(6.9) to 12 months7.0(6.1)
		(DSM-IV - SCID)		ACC
				Baseline 11.9(6.6) to 1 month 7.1(6.4) to 6 months 6.2(5.7) to 12 months 7.2(6.0)
				Relapse to Major Depression
				MBCT - 32.6%
				ACC - 30.4%
				Antidepressant use
				MBCT Baseline 30.4 to 1 month 28,1
				ACC Baseline 26.1to 1 month 22.2

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[TFN1] Note: BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; BDI-II = Beck Depression Inventory-II; MADRS = Escala de Classiﬁcação da Depressão de Montgomery (AsberMontgomery Asberg Depression Rating); HRSD = Hamilton Rating Scale for Depression; HAM-D 17 = Escala de Hamilton para Avaliação de Depressão; STAI-Y1= Spielberger State-Trait Anxiety Inventory form Y; RSQ = Ruminative Responses Scale; TSST = Trier Social Stress Test; BSI = Brief Symptom Inventory; IDS-SR ≥ 21 = Inventory of Depressive Symptomatology- Self Report; RRS = Ruminative Response Scale; ICD-10 = criteria; DSM-IV-TR Axis I e II = Research Version of the Structured Clinical Interview; BSS = Beck Scale for Suicide Ideation; IDS = depressive symptom; RRS = response patterns towards feelings of sadness/depression.