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Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression:
Marloes J Huijbers1, Philip Spinhoven2, Jan Spijker2
1Marloes J. Huijbers, MSc, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Philip Spinhoven, PhD, Institute of Psychology, Leiden University, Leiden and Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Jan Spijker, PhD, MD, Pro Persona Nijmegen, Nijmegen, The Netherlands; Henricus G. Ruhé, PhD, MD, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Digna J. F. van Schaik, PhD, MD, Patricia van Oppen, PhD, GGZ InGeest and Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands, Willem A. Nolen, PhD, MD, Johan Ormel, PhD, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Willem Kuyken, PhD, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Gert Jan van der Wilt, PhD, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Marc B. J. Blom, PhD, MD, Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands; Aart H. Schene, PhD, MD, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; A. Rogier T. Donders, PhD, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Anne E. M. Speckens, PhD, MD, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands marloes.huijbers@radboudumc.nl.
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 randomised controlled non-inferiority trial (ClinicalTrials.gov:NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n= 249), were randomly 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.
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