A new article published in JAMA Psychiatry finds that mindfulness based stress reduction (MBSR) is as effective in treating anxiety disorders as the antidepressant escitalopram.
According to the current research by Elizabeth Hoge from Georgetown University, MBSR is safer and has fewer adverse effects than escitalopram. The authors write:
“Our prospective randomized clinical trial found that MBSR was noninferior to escitalopram for the treatment of anxiety disorders. In addition, MBSR was safe and well tolerated, with fewer adverse events associated with treatment compared with escitalopram.”
The goal of the current research was to compare an mindfulness program to the antidepressant escitalopram for the treatment of anxiety disorders. The researchers recruited 276 participants from Boston, New York, and Washington, D.C. hospitals to accomplish this goal. To be eligible for the study, participants had to be between 18 and 75 years old and have a primary diagnosis of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia.
Participants were excluded if they were diagnosed with lifetime bipolar disorder, psychotic disorders, obsessive-compulsive disorder, anorexia, bulimia, post-traumatic stress disorder, substance use disorder, or suicidal ideation. Additionally, participants were excluded if they had completed MBSR training in the past year, had a daily meditation practice, or were taking psychiatric medications (excluding trazodone, sleep medications, and benzodiazepines).
Participants were randomly assigned to the mindfulness or the escitalopram group. People assigned to the MBSR group participated in weekly 2.5-hour classes and a 45-minute daily MBSR home practice for eight weeks. These participants also attended a day-long retreat MBSR class during week 5 or 6 of the program. People assigned to the escitalopram group were started on 10mg daily doses of the drug. At week 2, the dosage was increased to 20mg for participants with positive results and delayed for participants with negative results. This continued for eight weeks, at which time participants who wished to continue taking escitalopram were assisted in doing so. Of the 276 participants initially recruited for the study, 208 (102 in the MBSR group and 106 in the escitalopram group) completed the trial. The researchers measured anxiety levels in participants using the Clinical Global Impression Severity Scale (CGI-S).
Baseline anxiety scores, as measured by the CGI-S, were 4.44 – 4.49 in the MBSR group and 4.51 – 4.54 in the escitalopram group. At the end of the 8-week study, the mean CGI-S score for the MBSR group dropped by 1.35. For the escitalopram group, the mean CGI-S score decreased by 1.43. According to the authors, this indicates that the interventions are similarly effective.
Follow-up assessments after the end of the eight-week study also showed similar results. At 12 weeks, the mean CGI-S score for the MBSR group had dropped by 2.89 from the baseline compared to a 2.95 drop in the escitalopram group. At 24 weeks, the MBSR and escitalopram groups both saw an average decrease of 2.92 from their baseline CGI-S scores.
A total of 10 participants (8%) dropped out of the escitalopram group as a result of adverse events associated with the drug use. No participants dropped out of the MBSR group. One hundred ten participants (78.6%) from the escitalopram group experienced at least one adverse event related to the current study compared to 21 participants (15.4%) from the MBSR group.
The authors endorsed several limitations of the current research. The time and attention required for the MBSR group were significantly higher than for the escitalopram group. The sample was predominately female, with a relatively high level of education. Participants were also all recruited from 3 cities in the United States, significantly limiting generalizability to other populations. The authors conclude:
“In this trial, an MBSR was shown to be a well-tolerated treatment option with comparable effectiveness to a first-line medication for patients with anxiety disorders. Problematic habitual thought patterns characterize anxiety disorders, and mindfulness training specifically focuses the mind on the present moment; thus, individuals practice seeing thoughts and sensations as merely transient mental phenomena and not necessarily accurate reflections of reality. This reappraisal process improves emotion regulation, making individuals less reactive to thoughts and sensations. In addition, mindfulness is practiced with a nonjudgmental, accepting attitude, which over time appears to increase self-acceptance and self-compassion.”
Past research has shown that there is not sufficient evidence for the use of antidepressants such as escitalopram for the treatment of anxiety. Escitalopram has been linked to suicide in children. Antidepressant drugs commonly cause withdrawal when service users attempt to discontinue their use. Some service users have reported seizure-like symptoms and suicidality as a result of antidepressant drug use. Antidepressants have also been linked to other adverse effects such as neuronal damage, cognitive decline, impaired gastrointestinal functioning, sexual dysfunction, and increased risk of death in older people.
Research has also shown that mindfulness practices can reduce anxiety in people diagnosed with generalized anxiety disorder. A similar study found that school-based mindfulness programs led to a reduction in stress for middle school students.
Hoge, E., Bui, E., Mete, M. et al. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders A Randomized Clinical Trial. Jama Psychiatry. 80(1), 13-21 (2023). (Link)