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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.

Want to learn more about meditation?

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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

9 ways that college students can meet people

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

Some people think that humans by nature are social beings. That we need some degree of social connection/interaction with others to maintain our own well-being, manage stress, happiness, and overall emotional health.

Each person may need to tailor the amount and type of social interaction based on their personality, needs, and available options.

Is there any research on social support and mental health of college students?

There are many studies, some of them have found the following:

  • In one study of college students, lower perceived social support was found to have a 6 fold increase in depression risk relative to higher perceived social support (1).
  • Another study found that peer support benefits mental health (2).
  • In another study, social support from family and friends jointly influenced about 80 % of the effect of life satisfaction and hopelessness on drinking alcohol (3).
  • Finally, a study of about 1200 students found that students with higher social support had better mental health (4).

What 9 possible ways for college students to meet people, deal with loneliness, and increase social support?

  1. Check out the OSU campus student organizations page for organizations such as Active Minds, Peers Reaching out, Boo-Radley and others.
  2. OSU-Rec Sports has various play options.
  3. Check out over 1300 different student organizations focused on different interests/hobbies
  4. Consider relevant courses based around sports, or other hobbies/interests.
  5. Volunteer opportunities at OSU: https://engage.osu.edu/for-alumni-and-friends/volunteer-opportunities.html
  6. Therapy treatment Groups at CCS
  7. Support Groups in the community: National alliance on Mental Illness, Hands On Central Ohio 211.
  8. There are pros and cons of social media and online support communities.
  9. https://www.affordablecollegesonline.org/college-resource-center/social-support-campus/

Any additional resources?

Think of current or past friendships, relationships, etc. that have been meaningful/supportive.  Can you think of a way to periodically connect with them in person, online or by phone?

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. Hefner, J., & Eisenberg, D. (2009). Social support and mental health among college students. American Journal of Orthopsychiatry, 79(4), 491-499. http://dx.doi.org/10.1037/a0016918
  2. O’Connell MJ, Sledge WH, Staeheli M, Sells D, Costa M, Wieland M, Davidson L. Outcomes of a Peer Mentor Intervention for Persons With Recurrent Psychiatric Hospitalization. Psychiatr Serv. 2018 Apr 16:appips201600478. doi: 10.1176/appi.ps.201600478. [Epub ahead of print]
  3. Catie CW Lai and Cecilia MS Ma. The mediating role of social support in the relationship between psychological well-being and health-risk behaviors among Chinese university students. Health Psychology Open.  https://doi.org/10.1177/2055102916678106 First Published November 8, 2016
  4. Tahmasbipour, A. Taheri. A Survey on the Relation Between Social Support and Mental Health in Students Shahid Rajaee University. Procedia – Social and Behavioral Sciences. Volume 47, 2012, Pages 5-9, ISSN 1877-0428, https://doi.org/10.1016/j.sbspro.2012.06.603.

 

Alcohol and Grades

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

Almost 2 out of 3 college students reported binge drinking of alcohol in the last 30 days (1).
Adults ages 18 to 29 years had the highest proportion of people with alcohol disorders (2).

In the United States, a standard drink is defined as (12):
• 12 ounces of beer with 5 percent alcohol content
• 5 ounces of wine with 12 percent alcohol content
• 1.5 ounces of distilled spirits with 40 percent alcohol content

What is high risk drinking?
High risk, heavy drinking, or binge drinking, defined as 5 or more drinks on one occasion, can impact academics (3, 4, 5).
It is also related to:
• Academic problems (6)
• Fewer study hours (5,7)
• Lower reported grades (8)

How does heavy drinking impact your academic performance?
• Frequent heavy drinking is related to:
• Increased sleepiness (4)
• Disrupted sleep (4)
• Disrupted learning (9)
• Disrupted memory (9)
• Increased social and emotional problems over time (10)
These factors might cause you to miss classes, deadlines, or perform poorly.

What is low risk drinking?

 

 

https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Is-your-drinking-pattern-risky/Whats-Low-Risk-Drinking.aspx

Low risk DOES NOT mean no risk.
For some people a lower cutoff may be more beneficial.

Who should avoid alcohol?
It’s safest to avoid alcohol altogether if you are:
• Taking medications that interact with alcohol (11)
• Managing a medical condition that can be made worse by drinking (11)
• Underage (11)
• Planning to drive a vehicle or operate machinery(11)
• Pregnant or trying to become pregnant (11)
You should also avoid alcohol if you have a family history of addiction because of increased genetic risk of addiction.

Where can you learn more about alcohol?
How much is too much, strategies for cutting down, quitting can be found here:
• https://www.rethinkingdrinking.niaaa.nih.gov/Thinking-about-a-change/
• http://www.ccs.osu.edu/self-help/alcohol/
• Take the OSU Free Anonymous Mental health Screen

From what I have seen in practice and research, as we learn more about the impact of alcohol, the amount of alcohol that is considered safe continues to be lower than previously thought.

Are you regularly drinking too much alcohol? How is it impacting your academic, emotional and physical health?

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.  SAMHSA. 2014 National Survey on Drug Use and Health (NSDUH). Table 6.89B—Binge Alcohol Use in the Past Month among Persons Aged 18 to 22, \HWVGFGHNSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab6-89b 

2. Turrisi R, Larimer ME, Mallett KA, Kilmer JR, Ray AE, Mastroleo NR, et al. A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students. J Stud Alcohol Drugs. 2009;70:555–67.

3. El Ansari W, Stock C, Mills C. Is alcohol consumption associated with poor academic achievement in university students? Int J Prev Med (2013) 4(10):1175–88. 

4. Singleton RA, Jr, Wolfson AR. Alcohol consumption, sleep, and academic performance among college students. J Stud Alcohol Drugs. 2009;70:355–63. 

5. Wolaver AM. Effects of heavy drinking in college on study effort, grade point average, and major choice. Contemp Econ Policy. 2002;20:415–28.

6.  Wechsler H, Dowdall GW, Maenner G, Gledhill-Hoyt J, Lee H. Changes in binge drinking and related problems among American college students between 1993 and 1997. Results of the Harvard School of Public Health College Alcohol Study. J Am Coll Health. 1998;47:57–68. 

7. Webb E, Ashton CH, Kelly P, Kamali F. Alcohol and drug use in UK university students. Lancet. 1996;348:922–5. 

8. Engs RC, Diebold BA, Hanson DJ. The drinking patterns and problems of a national sample of college students. Journal of Alcohol and Drug Education. 1996;41:13–33.

 9. Zeigler DW, Wang CC, Yoast RA, Dickinson BD, McCaffree MA, Robinowitz CB, et al. The neurocognitive effects of alcohol on adolescents and college students. Prev Med. 2005;40:23–32.

10. Crosnoe R, Benner AD, Schneider B. Drinking, socioemotional functioning, and academic progress in secondary school. J Health Soc Behav. 2012;53:150–64.

11. https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Is-your-drinking-pattern-risky/Whats-Low-Risk-Drinking.aspx

12. The National Institute on alcohol abuse and alcoholism. https://pubs.niaaa.nih.gov/publications/collegefactsheet/Collegefactsheet.pdf