Mindfulness as Effective as Lexapro for Anxiety

Evidenced-based mindfulness practices prove to be just as effective for anxiety symptoms as the popular SSRI escitalopram.


Mindfulness-based stress reduction (MBSR) may be just as effective as the popular first-line anxiety medication escitalopram, commonly known as Lexapro. The study, published in JAMA Psychiatry in early November, is making mainstream news headlines for being the first to compare mindfulness training with an antidepressant directly. In addition, the results suggest that antidepressants need not be the only first-line intervention for anxiety.

The authors, Elizabeth A. Hoge, Eric Bui, Mihriye Mete, Mary Ann Dutton, Amanda W. Baker, and Naomi M. Simon, in their randomized control trial, found a noninferior reduction in symptoms of anxiety in participants that were taught mindfulness and mediation compared to participants who were given escitalopram.

“Anxiety disorders are the most common type of mental disorder, currently affecting an estimated 301 million people globally,” the authors write.
“Mindfulness meditation has been found to help reduce anxiety; a recent meta-analysis of trials with anxiety disorders found a significant benefit with mindfulness meditation compared with treatment as usual…Mindfulness-based stress reduction (MSBR) is the most widely researched [mindfulness-based intervention] MBI (over 1000 citations in PubMed and is available internationally). To our knowledge, no clinical trial comparing evidenced based MBI, such as MBSR, with a first-line pharmacological treatment for anxiety disorders has been published.” 

The US-based authors sought to fill this gap. The randomized clinical trial, ‘Treatments for Anxiety: Meditation and Escitalopram’ or ‘TAME,’ was conducted in three major US cities (Boston, Washington DC, and New York City) from June 2018 to February 2020.

After recruitment, 208 participants completed the trial. To be eligible for the trial, the participants must have been between 18 to 75 with a current and primary diagnosis of generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, or agoraphobia. Whereas individuals with a diagnosis of lifetime bipolar disorder, a psychotic disorder, obsessive-compulsive disorder, or a current diagnosis of anorexia or bulimia nervosa, posttraumatic stress disorder, substance abuse disorder, and or significant active suicidality were non-eligible.

Notably, patients taking psychiatric medications were excluded unless the drugs were trazodone (less than 100 mg), certain sleep medications, and any benzodiazepine, so long as a stable dose was established a month prior.

After eligibility requirements were met, the participants were interviewed by a study clinician at one of the three hospitals on the East Coast of the United States. The study clinician was assigned to each patient randomly via a computer-generated block-randomization schedule. This randomization was to ensure that the patient’s baseline severity of anxiety was distributed randomly across sites, clinicians, and interventions. Baseline anxiety severity was measured by the scale Clinical Global Impression of Severity (CGI-S), with low-baseline anxiety being less than or equal to 4 and high-baseline anxiety being greater than four. The two interventions were assigned to the mindfulness-based stress reduction (MBSR) group or the escitalopram (Lexapro) group.

The MBSR group attended one 2.5-hour MBSR class once a week for 8 weeks taught by a qualified mindfulness instructor. Some practices in the class were: focusing attention on one’s breath, full body scans, and mindful movement. Participants assigned to the MBSR group also attended a day-long retreat weekend class in the fifth or sixth week and were given 45-minute at-home practice exercises.

The escitalopram group was given 10mg of the SSRI daily and, if well tolerated, increased to 20mg at week two. The participants checked in with their study clinician throughout the trial. At the end of the intervention, the authors ran multiple statistical analyses to determine treatment-group differences. In addition, a linear regression model of each patient’s CGI-S score was used to discern the difference in the reduction/management of anxiety symptoms between intervention groups.

The authors summarize their results.

“Primary outcome analyses in those who completed the trial at week 8 showed noninferiority for CGI-S score improvement with MBSR compared with escitalopram.”

In other words, the authors found that the MBSR groups’ reduction in the severity of anxiety was not significantly different from that of the Lexapro group.

Of course, like all studies, this study has its fair share of limitations. In particular, the completion rate of the mindfulness-intervention group was 75% and 76% for the escitalopram group, respectively. However, at a 12-week follow-up, only 49% of the mindfulness group continued their meditation practice, whereas 78% of the Lexapro group continued their drug regimen. The adherence to the intervention worsens over time: at 24 weeks, only 28% of the MSBR group continued practicing mindfulness, and 52% continued to take Lexapro. Additional limitations include the study population—mostly well-educated White women. Moreover, given that the study sites are major US metropolitan areas, it makes it challenging to generalize these findings to diverse groups of people and different geographical regions.

Additionally, the authors note that “MBSR in this trial was delivered in person, with trained mediation teachers available weekly to answer questions and guide practices, limiting any extrapolation in support of mindfulness apps or programs that are delivered over the internet.”

Although multiple other studies in the past have shown that mindfulness can lead to decreases in anxiety and depression, this study has gained national attention as it directly compares the efficacy of an evidenced-based mindfulness therapy to that of a popular SSRI, escitalopram.

The scientific study of contemplative practices is increasingly gaining traction in the United States and may provide an avenue toward reducing polypharmacy practices and long-term psychotropic drug use.



Hoge, E. A., Bui, E., Mete, M., Dutton, M. A., Baker, A. W., & Simon, N. M. Mindfulness-Based Stress Reduction vs. Escitalopram for the Treatment of Adults With Anxiety         Disorders: A Randomized Clinical Trial. JAMA psychiatry. (Link)


    • From “The Power of Now” by Eckhart Tolle

      Pages 63, 64

      “…..Touch something — anything — and feel and acknowledge its Being. Observe the rhythm of your breathing; feel the air flowing in and out, feel the life energy inside your body. Allow everything to be, within and without. Allow the “isness” of all things. Move deeply into the Now.

      You are leaving behind the deadening world of mental abstraction, of time. You are getting out of the insane mind that is draining you of life energy, just as it is slowly poisoning and destroying the Earth.

      You are awakening out of the dream of time into the present.

      Q. It feels as if a heavy burden has been lifted. A sense of lightness. I feel clear. . . but my problems are still there waiting for me, aren’t they? They haven’t been solved. Am I not just temporarily evading them? If you found yourself in paradise, it wouldn’t be long before your mind would say “yes, but. . . .”

      A. Ultimately, this is not about solving your problems. It’s about realizing that there are no problems. Only situations — to be dealt with now, or to be left alone and accepted as part of the “isness” of the present moment until they change or can be dealt with.

      Problems are mind-made and need time to survive. They cannot survive in the actuality of the Now. Focus your attention on the Now and tell me what problem you have at this moment….”

      In my experience it works (with practice).

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      • I’d also submit that if they have the same “outcome measures,” whatever that means, then mindfulness is MUCH more “effective” because no one has to tolerate the potentially horrific and even dangerous “side effects” of the drug. Any non-drug alternative that is judges to have similar effects should be considered a HUGE improvement over any drug option for that reason, even within their own strained structure of “reasoning.”

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      • Topher, I thought the same things before reading the article. And then this sentence: “After eligibility requirements were met, the participants were interviewed by a study clinician at one of the three hospitals on the East Coast of the United States.”
        (!?) I’m not under the impression that clinicians from hospitals regarding how they evaluate anxiety is helping one way or the other, other than it seems to be more of a problem. How much are they causing paranoia regarding anxiety, and anyone wanting to dowse what otherwise might function to point out stuff that’s uncomfortable to the status quote, they get points for then “not” being anxious? What is going on when people want to dowse anxiety rather than feel it to see why it’s there, and how much is simply pushing it away the problem that causes the discomfort rather than the anxiety itself? What does this say regarding the results of these interviews? Is this the same as people deciding you’re going to Heaven if you park yourself in church every so often, or repeat said doctrines? The ones going to church show signs they will go to “Heaven” because they are less anxious about it? They get above a 4. It’s not listed how they determine what anxiety above 4 is. What does that have to do with deadened feelings or senses to what’s going on that might cause needed anxiety so one is aware of it? Or does mindfulness also cause in the end serotonin sluggishness like anti-depressants have been proven to? Or the fluctuating from too much to not enough within a period of initiation of the drug, and in the end less serotonin, which then again increases exponentially would the drug be stopped? If you test a bunch of people regarding their reaction when an alarm goes off, and there’s a group that really just HATE the alarm, would giving those people ear muffs have proven that they reduce anxiety, and you can just ignore WHY the alarm went off? And having hospital personal make these evaluations regarding the efficacy of the ears muffs it this legitimate science?

        And as Steve mentioned one of the things regarded as reducing “anxiety” has a few more side effects than ear muffs?

        And will that relieve the “anxiety” of the hospital personal to know these side effects are treatable (or rather effects, I don’t know whether an anti-anxiety drug causing “psychosis” or “bipolar” is really just a side effect or basically an effect) where as mindfulness, if it’s liked might lure people away from medical treatment and thus something leaning towards alternatives is seen as indifference rather than a lessening of anxiety…..

        I might be over-interpreting and exaggerating a bit…..

        Maybe I should try some mindfulness to relieve that…..

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    • Dr Joanna Moncrieff and colleagues have recently published a convincing Research Paper on the ineffectiveness of SSRI drugs like Lexapro.

      But there are other people that are now attempting to raise the SSRI s from the dead.


      (…Spellbinding…sometimes people think psychiatric drugs are effective because – they feel so terrible when they try to come off them).

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