When Shrinks Put Mindfulness On The Couch

By Alexandra Morris
CommonHealth intern

Can medications and meditation co-exist?

Or, put another way, does mindfulness — the deliberate act of paying attention to the present moment and observing your thoughts drift by — have a place in psychiatric care?

The answer, according to some doctors: yes, maybe, at least for some patients.

At a conference held earlier this month at the University of Massachusetts Medical School, psychiatrists David Lovas of Dalhousie University and Zev Schuman-Olivier of Harvard Medical School and the Cambridge Health Alliance made the case for and against mindfulness and psychiatric drugs in treating patients with depression, anxiety, schizophrenia, bipolar disorder, and other mental illnesses.

Over the past twenty years or so, the number of patients taking antidepressants and antipsychotics has increased substantially. And in many cases, patients are on multiple drugs at once: one third of psychiatric outpatients are on three or more drugs, according to one study.

(Synergy by Jasmine/flickr)

(Synergy by Jasmine/flickr)

So researchers have begun to examine whether mindfulness, which can include walking meditation, body scan meditation (to bring awareness to each part of the body in turn), mindful eating or yoga, or mindful listening can significantly reduce some of the anxiety and distress associated with such illnesses.

“We’re witnessing a culture that is focused and organized in some ways around medication as a primary form of treatment,” said Schuman-Olivier. “On the other hand, people can overstate the power of mindfulness intervention.”

It’s a careful balancing act, they say: for some, mindfulness-based therapy may be more effective at relieving stress and addressing mental health symptoms, while others may benefit more from medications or a combination of medication and meditation.

In some cases, mindfulness can produce negative side effects – it has been shown to draw out negative memories of past events.

Still, mindfulness meditation is being adopted more and more as a practice to improve health and mental well-being. The U.S. Marines, for example, are using these meditation practices to improve their attention and working memory, according to a recent New York Times report.

Earlier this year, JAMA Internal Medicine published a paper that looked at how mindfulness meditation programs affect stress and well-being. The study, widely covered by the news media, reviewed 47 studies and found that the meditation programs helped improve levels of anxiety, depression, and pain, although it did not have an effect on sleep, weight, or substance abuse.

In the discussion, the researchers compared the effect of meditation to the effect of antidepressant treatment. But what they failed to discuss, said Lovas, was the fact that in a good proportion of the studies analyzed, a number of patients were still taking medications.

From the study:

“During the course of 2 to 6 months, the mindfulness meditation program effect size estimates ranged from 0.22 to 0.38 for anxiety symptoms and 0.23 to 0.30 for depressive symptoms. These small effects are comparable with what would be expected from the use of an antidepressant in a primary care population but without the associated toxicities.”

“We’re not saying this is comparable in terms of a head to head trial,” said Dr. Madhav Goyal of Johns Hopkins University’s Department of Medicine and lead author of the JAMA paper. “It’s not a statement that’s saying you can replace antidepressants with this. What it’s saying is that we’re finding an effect of these programs and the effect is something that is at least as big as what you would see with an antidepressant in other studies, and that’s something to pay attention to.”

Nevertheless, some media outlets framed the study as a direct comparison: mindfulness vs. drug treatment. In Forbes, for example, the headline read: For Depression Treatment, Meditation Might Rival Medication. And in the Boston Globe: Can Meditation Top Medication?

“We have to be humble and cautious when we’re discussing mindfulness interventions with people in terms of how beneficial it might be,” said Lovas. “We don’t know for sure in all cases if this this means you can come off medications completely and just use mindfulness.”

It shouldn’t be a question of one or the other, said the psychiatrists. “Mindfulness is not a panacea nor are medications,” said Lovas. Each patient is different. What works for one person may not make sense for another.

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  • ExpatEUTherapist

    I have been involved in treating depressed patients as a psychotherapist and in depression research for almost 40 years. In my experience treating most depression as if it were a physical malady is like blaming your television for showing soap operas. There are some instances where depression’s cause may be physical but most depression is not. It does work for the pharmaceutical companies though. The physical health factors affected by depression are many and can often be extremely
    serious. For those willing to try a psychological/spiritual approach, (not
    religious), including mindfulness, to dealing with depression I found this very
    helpful website. I recommend it to many of my psychotherapy clients with whom I
    am working with for depression. http://depression.lightunlimitedpublishing.com.
    The tools offered actually work for those willing to apply themselves. Having
    worked with depressed clients for 40 years I find that therapy with a
    psychotherapist who has experience with depression and some good self-help
    tools like those mentioned above are a good long term solution to ending
    depression. It takes real commitment on the part of the depressed individual to
    getting out of that dark place but it can be done.

  • Anon Y. Mous

    I’m a conservative Christian. I have difficulties with the practices taught in MBSR classes because many of the techniques are straight out of Buddhism and are heretical. I have a problem with any meditation practice where you engage in thought stopping. I’m also upset that the people who developed these programs failed to look int Christian practices, for they might be more culturally appropriate. Also, there is now research that sustained engagement in creative activities, such as crafts, art or music, is at least as beneficial as MBSR…. may be more beneficial AND more acceptable.

    • Mark D Shellhammer

      Actually, much of Kabatt-Zinn’s work comes from Christian Centering Prayer as well as the practice of Buddhist meditation.

  • Bella

    I had rather severe anxiety and depression for a few years. I found mindfulness/ACT (using a workbook, not a therapist) quite helpful with the anxiety, but not so much with the depression. The depression made me not care about anything, so trying to live in accordance with my values regardless of how I felt was difficult since by that time I didn’t value anything. It finally reached a point where I realized I needed medical help and went to my primary care doc for antidepressents. They were nothing short of miraculous. I did go to therapy briefly after starting them, but the therapist said I didn’t need it, that my problems had been chemical. He was right.

  • Christine

    i have witnessed an individual with depression try to practice mindfulness. it was a struggle for him to come in contact with so much negative emotion. but mindfulness can help to accept this suffering. because the arrow of depression is already there. mindfulness helps to ensure that unnecessary arrows, like judging and self-hate, aren’t added to the wound. it provides spaciousness for healing to take place.

    it is true that psychiatric medications have a lot of side-effects. However, what’s worse than taking antidepressants is taking antidepressants and feeling bad about it – again, adding more arrows to the wound. i don’t feel that medications are a bad thing, and may sometimes be necessary – however, i feel that mindfulness can be helpful regardless.

    because what is mindfulness really? it’s being here fully in the present moment so that we don’t miss our appointment with life, the miracle of life. i’m not sure what could be more important than that.

    yes mindfulness may draw out negative emotions from the past when we decide to stop running away from our suffering – and this may be very difficult for someone with depression. so medication may have a place in making that person feel more happy and motivated. it’s also helpful to water the positive seeds within ourselves and others. when we’re able to cultivate some joy and peace, it can help us feel more brave to confront our suffering.

    mindfulness is a practice, a journey into the present moment. it is only possible to be mindful in the present moment, yet it takes time and effort to transform our suffering. it’s not a quick, easy fix or a band-aid. it’s a loving transformation and the greatest gift we can give ourselves and each other.

  • cuvtixo

    Just a breif note: since there’s a ‘P’ in psychology, psychiatrist, and so on, I spell pshrink with a ‘P’ as well.
    Just a helpful hint that confirms in writing that one is not referring to the other type of “shrinking.” Carry on.

  • bethchesneyframpton

    My therapy approach is Acceptance and Commitment Therapy (ACT). Present moment awareness is one of its basic tenets.

  • Labyrinthia

    Usually mindfulness is combined with cognitive behavioral therapy. Most “third wave” CBT styles incorporate mindfulness, acceptance, etc. Before CBT was almost myopically focused on change, which worked well for people with mild to moderate difficulties, but when you’re talking about people with severe and chronic illnesses it often fell short.

  • CassieMcD

    I’m a little uncomfortable with the publicity mindfulness is getting, as if it’s some new idea. It’s not the Next Big Thing, and people need to be treated individually.

  • Chelsea

    “Mindfulness is not a panacea, nor are medications.” I think it’s incredibly important to remember that. I don’t think that any one thing is a cure-all, because every person is different. Mental health is similar to physical health in that way: one treatment may work for one person but may not be effective for another. As long as that is kept in mind and a true understanding of meditation is present, then I believe that mindfulness can help almost everyone in one way or another. I started meditating on the advice of a friend, who recommended the meditationSHIFT course. It was simple and easy to understand, and although I began the course with a reduction of anxiety in mind, it has helped with so much more than that.

    Good article.