MBCT and Escitalopram for Treatment-Resistant Depression in Older Adults

Combining Mindfulness-Based Cognitive Therapy With Escitalopram for Cognitive and Emotional Recovery in Older Adults With Treatment-Resistant Depression

This study is a randomized controlled trial designed to investigate the synergistic effects of combining mindfulness-based cognitive therapy (MBCT) with escitalopram hydrobromide versus escitalopram alone on cognitive function, depressive symptoms, and quality of life in older adults diagnosed with treatment-resistant depression (TRD) and cognitive impairment.

Treatment-resistant depression (TRD) in older adults presents a significant clinical challenge, often accompanied by cognitive impairment that affects daily functioning and well-being. While escitalopram is a standard pharmacological treatment, monotherapy may be insufficient for this population. Mindfulness-Based Cognitive Therapy (MBCT) has emerged as a promising psychotherapeutic intervention for depression by promoting awareness and altering negative thought patterns. This study aimed to evaluate if an integrated approach of MBCT plus escitalopram would yield superior outcomes compared to escitalopram alone. A total of 230 older adults with TRD were randomized to either a combined therapy group or a medication-only control group. Assessments of cognitive function (MoCA), depression severity (HAM-D), and quality of life (GQOLI-74) were conducted at baseline, 6 weeks, and 12 weeks to determine the efficacy of the combined intervention.

Inclusion Criteria:

• Aged between 60 and 77 years.
• Montreal Cognitive Assessment (MoCA) scores ranging from 5 to 17.
• Diagnosis of persistent and treatment-resistant depression according to DSM-5 criteria.
• Maintained consistent use of escitalopram hydrobromide for the previous 6 months.
• Ability to independently perform daily tasks.
• Provided written informed consent and willing to adhere to study procedures and follow-up.

Exclusion Criteria:

• Primary diagnosis of schizophrenia, bipolar disorder, or other significant mental health conditions other than depression.
• Presence of advanced cancer, end-stage heart disease, or severe liver or kidney dysfunction.
• Recent history (within 12 months) of substance abuse or addiction.
• Significant visual or hearing impairments that would hinder participation.
• Participation in mindfulness therapy or similar CBT within the last year.
• Language comprehension or expression challenges precluding participation.