Is breathing-based meditation intervention effective in managing major depressive disorder following inadequate response to antidepressants?
Date of publication of the randomized controlled trial: January 2017
Design
Randomized controlled trial (RCT).
Participants
25 adults (age range: 18 to 67 years, male %: 28%) who were diagnosed with a single or recurrent nonpsychotic episode of major depressive disorder, with a total score ≥ 14 points on the 17-item Hamilton Depression Rating Scale (HDRS-17). To be eligible, patients needed be on a stable (≥8 weeks) dose of antidepressant.
Intervention
Patients in breathing-based group over 8 weeks of practice weekly (1.5 to 3.5 hours per session). Yoga postures, sitting meditation and stress education were practiced.
Comparator
Comparison: 8-week of meditation versus waiting list control.
Major Outcomes
Outcome 1: Depression severity measured by HDRS-17. Higher score indicates more severe depression;
Outcome 2: Depression severity measured by Beck Depression Inventory (BDI). Higher score indicates more severe depression;
Outcome 3: Anxiety severity measured by Beck Anxiety Inventory (BAI). Higher score indicates more severe anxiety.
Settings
This trial was performed in an outpatient setting.
Comparison    Meditation versus waiting list control
Main Results
Compared to waiting list control, meditation was significantly superior in reducing depression measured by HDRS-17 (mean difference (MD): -10.27, 95% Cl: -15.50 to -5.04) and BDI score (MD: -15.48, 95% Cl: -22.62 to -8.34).
Comparison: Meditation versus waiting list control among adults with major depressive disorder
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (25) NR/13 NR/12 Not applicable as there is only 1 study. -10.27 (-15.50 to -5.04) 0.0032 Very high
2 1 (25) NR/13 NR/12 Not applicable as there is only 1 study. -15.48 (-22.62 to -8.34) 0.0101 Very high
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval; NR = not reported.
Comparison    Meditation versus waiting list control
Main Results
Compared to waiting list control, meditation was significantly superior in reducing anxiety severity as measured by BAI score (MD: -5.19, 95% Cl: -9.34 to -0.93).
Comparison: Meditation versus waiting list control among adults with major depressive disorder
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
3 1 (25) NR /13 NR /12 Not applicable as there is only 1 study. -5.19 (-9.34 to -0.93) 0.0097 High
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval; NR = not reported.
Comparison    Meditation versus waiting list control
Main Results
Compared to waiting list control, meditation was significantly superior in reducing depression measured by HDRS-17 (mean difference (MD): -10.27, 95% Cl: -15.50 to -5.04) and BDI score (MD: -15.48, 95% Cl: -22.62 to -8.34).
Comparison: Meditation versus waiting list control among adults with major depressive disorder
Outcomes 1 2
No. of studies (Total number of participants) 1 (25) 1 (25)
Mean score (SD)/ No. of participants Intervention NR/13 NR/13
Comparator NR/12 NR/12
MD (95% CI) -10.27 (-15.50 to -5.04) -15.48 (-22.62 to -8.34)
p value 0.0032 0.0101
Overall quality of evidence* Very high Very high
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval; NR = not reported.
Comparison    Meditation versus waiting list control
Main Results
Compared to waiting list control, meditation was significantly superior in reducing anxiety severity as measured by BAI score (MD: -5.19, 95% Cl: -9.34 to -0.93).
Comparison: Meditation versus waiting list control among adults with major depressive disorder
Outcomes 3
No. of studies (Total number of participants) 1 (25)
Mean score (SD)/ No. of participants Intervention NR /13
Comparator NR /12
MD (95% CI) -5.19 (-9.34 to -0.93)
p value 0.0097
Overall quality of evidence* High
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval; NR = not reported.
Conclusion
Benefits
Compared to the waiting list control, the 8-week meditation significantly reduces both depression and anxiety levels in patients with major depressive disorder. For outcomes 1 and 2, the overall quality of evidence is very high. Further research is most unlikely to have an important impact on our confidence in this estimate of effect. For outcome 3, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/27898207
The synopsis is based on the following article:
Sharma A, Barrett MS, Cucchiara AJ, Gooneratne NS, Thase ME. A breathing-based meditation intervention for patients with major depressive disorder following inadequate response to antidepressants: a randomized pilot study. The Journal of clinical psychiatry. 2017 Jan;78(1):e59.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.