Efeito adjunto do mindfulness no tratamento do Transtorno Depressivo Maior

Abstract

Currently, the usual treatment for Major Depressive Disorder (MDD) is antidepressant medication. However, several issues surround pharmacotherapy, such as the delayed latency in clinical improvement, adverse effects, and limited efficacy. Considering this, efforts have been directed toward investigating complementary treatments that can enhance the efficacy of pharmacotherapy without increasing its side effects. In this regard, mindfulness has been considered, which uses meditation focused on the sensations of breath and body as its main intervention tool. Therefore, in this doctoral study, we evaluated the adjunctive response of mindfulness in the treatment of MDD through the assessment of clinical and biological responses. We compared the efficacy of escitalopram therapy (Escitalopram Group) with homebased, and supervised mindfulness + escitalopram therapy (Mindfulness Group) in adults with MDD, students and staff from UFRN (Universidade Federal do Rio Grande do Norte), over 12 weeks. The interventions are part of the Coping with Sadness Program, which offers other modalities of complementary therapy, such as exercise and yoga. Psychological and biochemical data were collected at three time points throughout the intervention (before, and at weeks 5 and 12). An association was found between trait mindfulness and lower baseline severity of depression-related symptoms, such as depressive and anxiety symptoms, selfesteem, and sleep quality. The Mindfulness Group outperformed the Escitalopram Group in terms of self-reported depressive symptoms, showing a lower score at the end of treatment, with this reduction predicted by an increase in trait mindfulness. The reduction in depressive symptoms assessed by the psychiatrist was similar for both groups, with remission rates of 43% in the Mindfulness Group and 37% in the Escitalopram Group. In addition, the presence of side effects did not differ between the groups. Finally, an increase in the inflammatory response over the course of treatment was observed in the Escitalopram Group, but not in the Mindfulness Group. These results highlight the utility of mindfulness in changing the individual’s relationship with depressive symptoms through mindfulness training, as well as in preventing the inflammatory response triggered by medication. Therefore, this supports the use of mindfulness as a personalized, low-cost, and flexible complementary therapy, with high potential for applicability in psychiatric clinical practice.