Mindfulness Meditation vs Escitalopram for Treatment of Anxiety Disorders

A new study published in the Journal of American Medical Association found that mindfulness meditation seems to reduce anxiety symptoms after 8 weeks similarly to escitalopram. Anxiety disorders have demonstrated the effectiveness of mindfulness-based therapies, such as mindfulness-based stress reduction (MBSR). The previously published randomized clinical trial with a predefined margin showed that 8 weeks of MBSR was non-inferior to escitalopram for the treatment of anxiety disorders. Therefore, Hiroe Hu and colleagues provided the secondary outcomes of the trial, such as depression, anxiety, and quality of life (QOL) as stated by the patients.

Prior to 1:1 randomization, the trial comprised community-dwelling people with a main anxiety condition (agoraphobia, generalized anxiety, panic, or social anxiety disorder) identified by a doctor. The MBSR intervention includes weekly courses that covered the philosophy and practice of several kinds of mindfulness meditation. Escitalopram participants were given a flexible dosage (10-20 mg/d) and visited with a prescriber at baseline, weeks 1, 2, 4, 6, 8, and 12. The trial protocol was approved by local institutional review boards, and the patients gave their informed permission. Blinded assessors evaluated anxiety results reported by both patients and clinicians.

Depression symptoms were measured using the PROMIS Depression scale, while QOL and role functioning were measured using the PROMIS Satisfaction. Bivariate statistics and multivariable regression analysis were employed to compare the groups. The intent-to-treat principle was applied to adjusted analyses, which employed linear mixed models that included every participant at baseline regardless of missing data at later time points.

This study involved a total of 276 individuals. The participants were indicated as Asian, Hispanic, or a different race or ethnicity. Except for BAI scores, there were no significant differences between the groups in demographic variables or baseline outcome measures. The participants in both groups reported reduced anxiety symptoms, with between-group variations matching to minor effect sizes.

No substantial variations were found at week 8 (the major end point). At week 4 (mid-treatment), substantial variations in PROMIS Anxiety and PROMIS Depression scores developed, with escitalopram providing more improvement, despite these differences were no longer significant by week 8. However, 110 escitalopram users (78.6%) reported at least one study-related adverse event when compared to 21 MBSR patients. Overall, these results are in line with other research showing that mindfulness may effectively treat panic and social anxiety disorders.

Reference

Hu, H., Mete, M., Rustgi, N. K., Washington, C. I., Sanghavi, K., Dutton, M. A., Simon, N. M., Baker, A. W., Bui, E., & Hoge, E. A. (2024). Mindfulness Meditation vs Escitalopram for Treatment of Anxiety Disorders. In JAMA Network Open (Vol. 7, Issue 10, p. e2438453). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.38453