Mindfulness meditation vs escitalopram for anxiety

Mindfulness meditation has been shown to have various mental health benefits. For example, a review of 13 studies showed improvement in ADHD symptoms with mindfulness meditation (1).

Also, 41 trials show mindfulness meditation helped improve stress related outcomes such as anxiety, depression, stress, positive mood, etc. (2)

A review of 14 clinical trials shows meditation being more effective than relaxation techniques for anxiety (3).

A recent study looked at whether mindfulness based stress reduction (MBSR) was as effective as an anti-anxiety medication Lexapro (escitalopram) (4).

Who was in the study? (4)

  • 102 participants in MBSR and 106 participants in the escitalopram group, with a mean age of 33 years (4).
  • Participants were mostly female (4).

How was anxiety measured (4)?

  • Clinical Global Impression of Severity scale (CGI-S) was performed by blinded clinical interviewer at baseline, week 8 end point, and follow-up visits at 12 and 24 weeks (4).
  • Primary patient reported measure was the Overall Anxiety Severity and Impairment Scale (OASIS) (4).

What was the intervention? (4)

  • Participants were randomized 1:1 to 8 weeks of the weekly MBSR course or the antidepressant escitalopram, flexibly dosed from 10 to 20 mg (4).
  • MBSR group was taught MBSR as a manualized 8-week protocol with 45 minute daily home practice exercises, weekly 2.5-hour long classes, a day-long retreat weekend class during the fifth or sixth week (5).
  • Participants were taught several forms of mindfulness meditation, such as breath awareness (focusing attention on the breath and other physical sensations), a body scan (directing attention to one body part at a time and observing how that body part feels), and mindful movement (stretching and movements designed to bring awareness to the body and increase interoceptive awareness) (4,5).

What were the results? (4)

Participants who completed the trial at week 8 showed noninferiority for CGI-S score improvement with MBSR compared with escitalopram (4)—meaning MBSR was as effective as escitalopram.

What are some caveats?

  • This is the first study to compare MBSR to medication (4).
  • The study did not use commonly used instruments to measure anxiety in clinical settings such as GAD-7, Hamilton rating scale for anxiety or the Beck anxiety inventory, etc.
  • Participants had any anxiety disorder, not a specific type of anxiety disorder such as generalized anxiety disorder, panic disorder etc (4) which make it difficult to generalize results for other populations.
  • Participants (4) were mostly female in the 30’s which makes it difficult to generalize results for other populations.
  • MBSR is a specific type of manualized meditation taught by qualified instructors (5) and it may be difficult to find qualified instructors or qualified classes in your area.
  • In addition to work, school, and life obligations, people may find it difficult to schedule 45 minutes of daily meditation plus 2.5 hours of weekly class plus a day long retreat.
  • Different people may benefit from different types of meditation, and this area is being further researched.
  • Practicing meditation regularly may lead to improved benefits, and some people may see benefits with shorter duration of meditation.
  • Some people may find that mindfulness or too much mindfulness may worsen their symptoms (6), so you should check with your mental health professional if MBSR is appropriate for you.
  • Some mental health conditions may not be appropriate for MBSR, check with your mental health professional.

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By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Poissant, H., Mendrek, A., Talbot, N., Khoury, B., & Nolan, J. (2019). Behavioral and Cognitive Impacts of Mindfulness-Based Interventions on Adults with Attention-Deficit Hyperactivity Disorder: A Systematic Review. Behavioural neurology, 2019, 5682050. doi:10.1155/2019/5682050
  2. Goyal M, Singh S, Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-Being [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Jan. (Comparative Effectiveness Reviews, No. 124.)Available from: https://www.ncbi.nlm.nih.gov/books/NBK180102/
  3. Montero-Marin, J., Garcia-Campayo, J., Pérez-Yus, M., Zabaleta-del-Olmo, E., & Cuijpers, P. (n.d.). Meditation techniques v. relaxation therapies when treating anxiety: A meta-analytic review. Psychological Medicine,1-16. doi:10.1017/S0033291719001600
  4. Hoge, Elizabeth A et al. “Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial.” JAMA psychiatry, e223679. 9 Nov. 2022, doi:10.1001/jamapsychiatry.2022.3679
  5. Santorelli  SF, Kabat-Zinn  J, Blacker  M, Meleo-Meyer  F, Koerbel  L. Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide. Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Revised 2017. Accessed December 14, 2017. https://www.bangor.ac.uk/mindfulness/documents/mbsr-curriculum-guide-2017.pdf
  6. Britton, W. B., Lindahl, J. R., Cooper, D. J., Canby, N. K., & Palitsky, R. (2021). Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs. Clinical Psychological Science, 9(6), 1185–1204. https://doi.org/10.1177/2167702621996340