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Background and objectives Up to 50% of patients undergoing hemodialysis suffer from symptoms of depression and/or anxiety. Access to traditional pharmacotherapies and psychotherapies for depression or anxiety in this patient population has been inadequate. The objective of this study was to investigate the feasibility and effectiveness of brief mindfulness meditation intervention for patients on hemodialysis with depression and anxiety symptoms.Design, setting, participants, & measurements This study was a randomized, controlled, assessor-blinded trial conducted in an urban hemodialysis unit. Forty-one patients were randomly assigned to intervention (n=21) and treatment-as-usual (n=20) groups. The intervention group received an 8-week individual chairside meditation intervention lasting 10–15 minutes, three times a week during hemodialysis. Feasibility outcomes were primarily assessed: enrollment rates, intervention completion rates, and intervention tolerability. Symptoms of depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). Results Of those deemed eligible for the study, 67% enrolled (41 of 61). Of the participants randomized to the intervention group, 71% completed the study, with meditation being well tolerated (median rating of 8 of 10 in a Likert scale; interquartile range=10–5 of 10). Barriers to intervention delivery included frequent hemodialysis shift changes, interruptions by staff or alarms, space constraints, fluctuating participant medical status, and participant fatigue. Meditation was associated with subjective benefits but no statistically significant effect on depression scores (change in PHQ-9, −3.0±3.9 in the intervention group versus −2.0±4.7 in controls; P=0.45) or anxiety scores (change in GAD-7, −0.9±4.6 versus −0.8±4.8; P=0.91). Conclusions On the basis of the results of this study, mindfulness meditation appears to be feasible and well tolerated in patients on hemodialysis with anxiety and depression symptoms. The study did not reveal significant effects of the interventions on depression and anxiety scores.
Geriatric depression and anxiety are very common but difficult to treat pharmacologically; patients are more sensitive to adverse effects and respond relatively less well to medication.(1) Mindfulness-based cognitive therapy (MBCT) is a psychological therapy that has been highly effective in the treatment of psychiatric disorders, particularly in preventing relapse of depression.(2) However, there has only been one previous exploratory study examining its effectiveness in treating older adults.(3) We hypothesized that MBCT group psychotherapy will improve acute anxiety and depression in late life.We examined a retrospective case series of six geriatric outpatients (aged ≥ 60) with major depression and/or anxiety disorders who underwent an eight-week group MBCT course (2 hours per week) delivered by a psychiatrist (SR) in Fall 2014. Patients with normal cognition or mild cognitive impairment were included, while patients with dementia, acute psychosis, or acute suicidal ideation were excluded. Psychotropic medications were not adjusted during the treatment period. Ethics approval was obtained at Sunnybrook Health Sciences Centre in Toronto, Canada. We compared patients’ self-report scores on the Beck Anxiety Inventory (BAI), Beck Depression Inventory 2 (BDI-2), and Montreal Cognitive Assessment (MoCA) pre- and post-MBCT. Our patients were aged 66 to 82 (mean 74.5 ± 6.2), 66.7% were females, with an average of 4.8 (± 3.4) medical comorbidities and 6.3 (± 2.9) medications, including 1.0 (± 0.9) psychiatric medications. At baseline, patients (n = 6) had a mean BAI score of 24.5 (± 15.6), a BDI of 17.8 (± 12.8), and a MoCA of 27.0 (± 1.4). All patients completed the MBCT course and all self-reported enjoying the groups, with three patients attending all sessions and three patients missing only one session. Following MBCT, in patients with baseline anxiety (BAI > 7) (n = 5), the BAI score was significantly decreased by a mean of 37.7% (± 13.7) (range 26.1% to 57.1%) reduced from 28.0 (± 14.5) to 18.6 (± 11.8) (t = 6.7, p = .003). Considering patients with baseline depression (BDI > 7) (n = 4), the BDI score decreased by 33.3% (± 38.2) (range from 8.7% to 77.8%), reduced from 26 (± 2.1) to 17 (± 9.1), although likely due to our limited sample size, this result was non-significant (t = 1.78, p = .17). Patients’ cognition (n = 6) did not change meaningfully (mean +0.2 points increase in MoCA ± 1.8). At the end of the MBCT course, patients reported practicing formal mindfulness on their own an average of 3.6 times per week for 13.3 minutes/day. We observed strong effect sizes in both anxiety and depression for MBCT (Cohen’s d of 0.71 and 1.4, respectively), comparable to first-line antidepressants and individual cognitive behavioral therapy after generally longer treatment periods (e.g., a Cohen’s d of 0.4–1.3 after 15 weeks, with important placebo effects).(4,5) Our findings suggest that group MBCT could be an effective, well-tolerated, and health resource-efficient alternative and adjunct to current treatments in older adults. This appeared to be the case in our small sample of patients with an average symptom severity in the moderate-to-severe range. Future randomized controlled trials should further assess the effectiveness of MBCT in late-life anxiety and depression.