***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society . Medication and psychological therapies are effective for treating depression and maintenance anti-depressants ( m-ADM ) can prevent relapse . However , individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term . A recently developed treatment , mindfulness-based cognitive therapy ( MBCT ) , shows potential as a brief group program for people with recurring depression . This trial asks the policy research question ; is MBCT with support to taper/discontinue antidepressant medication ( MBCT-TS ) superior to m-ADM in terms of : a primary outcome of preventing depressive relapse/recurrence over 24 months ; and secondary outcomes of ( a ) depression free days , ( b ) residual depressive symptoms , ( c ) antidepressant medication ( ADM ) usage , ( d ) psychiatric and medical co-morbidity , ( e ) quality of life , and ( f ) cost effectiveness ? An explanatory research question also asks whether an increase in mindfulness skills is the key mechanism of change . The design is a single-blind , parallel r and omized controlled trial examining MBCT-TS versus m-ADM with an embedded process study . To answer the main policy research question the proposed trial compares MBCT-TS with m-ADM for patients with recurrent depression . Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care . Results Depressive relapse/recurrence over two years is the primary outcome variable . Analyses will be conducted following CONSORT st and ards and overseen by the trial ’s Data Monitoring and Safety Committee . Initial analyses will be conducted on an intention-to-treat basis , with subsequent analyses being per protocol . The explanatory question will be addressed in two mutually informative ways : quantitative measurement of potential mediating variables pre- and post-treatment and a qualitative study of service users ’ views and experiences . Conclusions If the results of our exploratory trial are extended to this definitive trial , MBCT-TS will be established as an alternative approach to maintenance antidepressants for people with a history of recurrent depression . The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches . Trial registration Trial registered 7 May 2009 ; IS RCT N26666654 BACKGROUND Previous studies have suggested that patients ' treatment preferences may influence treatment outcome . The current study investigated whether preference for either mindfulness-based cognitive therapy ( MBCT ) or maintenance antidepressant medication ( mADM ) to prevent relapse in recurrent depression was associated with patients ' characteristics , treatment adherence , or treatment outcome of MBCT . METHODS The data originated from two parallel r and omised controlled trials , the first comparing the combination of MBCT and mADM to MBCT in patients preferring MBCT ( n=249 ) , the second comparing the combination to mADM  alone in patients preferring mADM ( n=68 ) . Patients ' characteristics were compared across the trials ( n=317 ) . Subsequently , adherence and clinical outcomes were compared for patients who all received the combination ( n=154 ) . RESULTS Patients with a preference for mADM reported more previous depressive episodes and higher levels of mindfulness at baseline . Preference did not affect adherence to either MBCT or mADM . With regard to treatment outcome of MBCT added to mADM , preference was not associated with relapse/recurrence ( χ(2)=0.07 ; p=.80 ) , severity of ( residual ) depressive symptoms during the 15-month follow-up period ( β=-0.08 , p=.49 ) , or quality of life . LIMITATIONS The group preferring mADM was relatively small . The influence of preferences on outcome may have been limited in the current study because both preference groups received both interventions . CONCLUSIONS The fact that patients with a preference for medication did equally well as those with a preference for mindfulness supports the applicability of MBCT for recurrent depression . Future studies of MBCT should include measures of preferences to increase knowledge in this area BACKGROUND Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence .  Maintenance antidepressants for at least 2 years is the current recommended treatment , but many individuals are interested in alternatives to medication . Mindfulness-based cognitive therapy ( MBCT ) has been shown to reduce risk of relapse or recurrence compared with usual care , but has not yet been compared with maintenance antidepressant treatment in a definitive trial . We aim ed to see whether MBCT with support to taper or discontinue antidepressant treatment ( MBCT-TS ) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months . METHODS In this single-blind , parallel , group r and omised controlled trial ( PREVENT ) , we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants , from primary care general practice s in urban and rural setting s in the UK . Participants were r and omly assigned to either MBCT-TS or maintenance antidepressants ( in a 1:1 ratio ) with a computer-generated r and om number sequence with stratification by centre and symptomatic status . Participants were aware of treatment allocation and research assessors were masked to treatment allocation . The primary outcome was time to relapse or recurrence of depression , with patients followed up at five separate intervals during the 24-month study period . The primary analysis was based on the principle of intention to treat . The trial is registered with Current Controlled Trials , IS RCT N26666654 . FINDINGS Between March 23 , 2010 , and Oct 21 , 2011 , we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practice s. 212 patients were r and omly assigned to MBCT-TS and 212 to maintenance antidepressants . The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months ( hazard ratio 0·89 , 95 % CI 0·67 - 1·18 ; p=0·43 ) , nor did the number of serious adverse events . Five adverse events were reported , including two deaths , in each of the MBCT-TS and maintenance antidepressants groups . No adverse events were attributable to the interventions or the trial . INTERPRETATION We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence . Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence , residual depressive symptoms , and quality of life . FUNDING National Institute for Health Research ( NIHR ) Health Technology Assessment ( HTA ) programme , and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula Background Mindfulness-based cognitive therapy ( MBCT ) and maintenance antidepressant medication ( mADM ) both reduce the risk of relapse in recurrent depression , but their combination has not been studied . Aims To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM . Method A multicentre r and omised controlled non-inferiority trial ( Clinical Trials.gov : NCT00928980 ) . Adults with recurrent depression in remission , using mADM for 6 months or longer ( n = 249 ) , were r and omly allocated to either discontinue ( n = 128 ) or continue ( n = 121 ) mADM after MBCT . The primary outcome was depressive relapse/recurrence within 15 months . A confidence interval approach with a margin of 25 % was used to test non-inferiority . Key secondary outcomes were time to relapse/recurrence and depression severity . Results The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM . There were only minor differences in depression severity . Conclusions Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT For people at risk of depressive relapse , mindfulness-based cognitive therapy ( MBCT ) has an additive benefit to usual care ( H. F. Coelho , P. H. Canter , & E. Ernst , 2007 ) . This study asked if , among patients with recurrent depression who are treated with antidepressant medication ( ADM )  , MBCT is comparable to treatment with maintenance ADM ( m-ADM ) in ( a ) depressive relapse prevention , ( b ) key secondary outcomes , and ( c ) cost effectiveness . The study design was a parallel 2-group r and omized controlled trial comparing those on m-ADM ( N = 62 ) with those receiving MBCT plus support to taper/discontinue antidepressants ( N = 61 ) . Relapse/recurrence rates over 15-month follow-ups in MBCT were 47 % , compared with 60 % in the m-ADM group ( hazard ratio = 0.63 ; 95 % confidence interval : 0.39 to 1.04 ) . MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains . There was no difference in average annual cost between the 2 groups . Rates of ADM usage in the MBCT group was significantly reduced , and 46 patients ( 75 % ) completely discontinued their ADM . For patients treated with ADM , MBCT may provide an alternative approach for relapse prevention BACKGROUND Continuation of antidepressant medication ( ADM ) after remission is widely used to prevent depressive relapse/recurrence . Little is known about predictors of ADM use in terms of adherence , dosage , and successful tapering . The current study aim ed to explore beliefs about the causes of depression and recovery ( i.e. , causal beliefs ) and to examine whether they predict ADM use . METHODS The data were drawn from a controlled trial and an extension of this trial with additional experience sampling . In total , 289 remitted patients with recurrent depression ( ADM ≥ 6 months ) were r and omly assigned to Preventive Cognitive Therapy ( PCT ) with ADM tapering , PCT with maintenance ADM , or maintenance ADM alone . Adherence , ADM dosage , and causal beliefs regarding the first and last depressive episodes were explored via question naires . RESULTS Most patients mentioned stressful life events as cause of depression , although more patients tended to endorse external causes for the first episode and internal causes for the last episode . ADM  was most often mentioned as helpful during recovery from both episodes . Over half of all patients were adherent and under half of the patients in the tapering condition were able to complete the taper . Causal beliefs did not predict ADM use . CONCLUSIONS The results suggest that causal beliefs play little role in the use of maintenance ADM . More information is needed on factors contributing to successful tapering . The results must be interpreted with caution as this is not a naturalistic study and the results might be biased toward a more favorable view regarding ADM OBJECTIVE The purpose of this post hoc analysis was to evaluate the incidence and timing of taper/posttherapy-emergent adverse events ( TPAEs ) following discontinuation of long-term treatment with desvenlafaxine ( administered as desvenlafaxine succinate ) . METHOD This was a phase 4 , r and omized , double-blind , placebo-controlled study conducted at 38 research centers within the United States between March 2010 and February 2011 . Adult out patients with major depressive disorder ( MDD ; DSM-IV-TR criteria ) who completed 24 weeks of open-label treatment with desvenlafaxine 50 mg/d were r and omly assigned to 1 of 3 groups for the double-blind taper phase : desvenlafaxine 50 mg/d for 4 weeks ( no discontinuation ) , desvenlafaxine 25 mg/d for 1 week followed by placebo for 3 weeks ( taper ) , or placebo for 4 weeks ( abrupt discontinuation ) . The primary endpoint , Discontinuation-Emergent Signs and Symptoms Scale ( DESS ) score over the first 2 weeks of the taper phase , was described previously . Secondary assessment s included incidence and timing of TPAEs ( any adverse event that started or increased in severity during the double-blind phase ) and the percentage of patients who could not continue the taper phase due to discontinuation symptoms . The Quick Inventory of Depressive Symptomatology Self-Report ( QIDS-SR16 ) assessed MDD status . RESULTS A total of 480 patients enrolled in the open-label phase ; the full analysis set included 357 patients ( taper , n = 139 ; abrupt discontinuation , n = 146 ; no discontinuation , n = 72 ) . TPAEs occurred in all groups through week 4 . The incidence of any TPAE was lower for taper versus abrupt discontinuation at week 1 ( P < .001 ) , similar at week 2 , and lower for taper versus abrupt discontinuation at weeks 3 and 4 ( P ≤ .034 ) . The most common TPAEs ( incidence ≥ 3 % ) in the taper group were nausea and headache ( 3 % each ) at week 1 and dizziness ( 5 % ) and headache ( 4 % ) at week 2 . The most common TPAEs in the abrupt discontinuation group were dizziness ( 8 % ) , headache ( 8 % ) , nausea ( 4 % ) , irritability ( 3 % ) , and diarrhea ( 3 % ) at week 1 and headache ( 3 % ) at weeks 2 and 3 . The most common TPAE in the no discontinuation group was nausea ( 6 % ) at week 2 . 
    Output:
    
CONCLUSIONS Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence , but are re source intensive .