Mindfulness meditation reduces anxiety as much as an antidepressant

drawingA study conducted by a researcher from the University of Caen demonstrates the effectiveness of mindfulness meditation compared to drug therapy in the case of anxiety.

The clinical trial [1] conducted on a sample of 276 adults, published in November 2022 in the American scientific journal JAMA Psychiatry, carried out under the supervision of Doctor Elizabeth A. Hoge of the Department of Psychiatry at Georgetown University and the support of Éric Bui, psychiatrist , a researcher at the University of Caen, on stress reduction through a mindfulness meditation program compared to first-line psychopharmacology shows that the results of mindfulness meditation are equivalent to those of pharmacotherapy.

Mindfulness meditation more effective than medication for anxiety

This clinical trial is the first study that scientifically establishes that the results of mindfulness meditation are comparable to those of drug therapy for the treatment of anxiety disorders. Mindfulness meditation is also better tolerated, with fewer adverse effects, than drug therapy, knowing that it has been shown that, as shown by other studies, in particular that of Davidson et al. [2]the reduction in symptoms achieved with escitalopram is more effective than placebo.

Mindfulness meditation is therefore proving to be a well-tolerated and drug-like effective treatment option for patients with anxiety disorders. Mindfulness training focuses attention on the present moment. Individuals train to view thoughts and feelings as transitory phenomena that are not necessarily a reflection of reality. This process improves emotion regulation and patients become less responsive to thoughts and feelings. Also, mindfulness is practiced with a non-judgmental and accepting attitude which, over time, seems to increase self-acceptance and self-compassion.

The mindfulness meditation program

The MBSR program followed by patients is an 8-week protocol consisting of weekly 2.5-hour classes, a one-day retreat in the fifth or sixth week, and daily 45-minute exercises to be done individually at home. Participants took MBSR courses at clinics and community sites. Qualified instructors taught them the theory and practice of several forms of mindfulness meditation, such as breath awareness (focusing attention on the breath and body movements), body sweeping (directing attention to a part of the body) and mindful movement (stretching and movements intended to create awareness of the body and increase interoceptive awareness). A qualified MBSR instructor reviewed an audio recording of each instructor’s session to ensure consistency of treatment. Participants’ attendance was monitored by the instructors or through participants’ statements.

Escitalopram medication

The dose of escitalopram was initially 10 mg per day orally, increased to 20 mg per day by the second week if the drug was well tolerated or delayed if not. Treatment compliance was measured by pill count and patient report. Regular reviews were carried out with a clinician in weeks 1, 2, 4, 6 and 8. At the end of the trial, patients wishing to continue taking escitalopram were accompanied to do so.

Study methodology

Patients were recruited between June 2018 and February 2020. 276 adults with an anxiety disorder diagnosed at 3 urban US academic medical centers participated in the trial, 208 completed the trial. Participants were randomized to receive either the Mindfulness Meditation Program (MBSR) or an antidepressant, escitalopram, for 8 weeks. [3]. The primary outcome measured was the level of anxiety assessed on the Clinical Global Impression of Severity Scale (CGI-S), with a pre-determined non-inferiority margin of -0.495 points.

The primary sample was divided into 2 groups: 102 for MBSR and 106 for escitalopram. The average age of the patients was 33 years old. 156 participants (75%) were women. 32 participants (15%) were African American, 41 (20%) were Asian, 18 (9%) were Hispanic/Latino, 122 (59%) were White, and 13 (6%) were of other origin. The mean CGI-S score at the start of the trial was 4.44 for the MBSR group and 4.51 for the escitalopram group. At the end of the study, the mean CGI-S score was reduced by 1.35 for the MBSR group and by 1.43 for the escitalopram group. The difference between the two groups was -0.07, with the lower limit of the interval falling within the predefined non-inferiority margin of -0.495, indicating non-inferiority of MBSR to escitalopram. Of the patients who started treatment, 10 (8%) discontinued from the escitalopram group and none from the MBSR group due to adverse events. At least one study-related adverse event occurred in 110 participants randomized to escitalopram (78.6%) and 21 participants randomized to MBSR (15.4%).

[1] Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders – A Randomized Clinical Trial. Elizabeth A. Hoge, MD; Eric Bui, MD, PhD; Mihriye Mete, PhD; Mary Ann Dutton, PhD; Amanda W. Baker, PhD; Naomi M. Simon, MD, MSc

[2] Davidson JRT, Bose A, Korotzer A, Zheng H. Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study. Depress Anxiety. 2004;19(4): 234-240. doi:10.1002/da.10146

[3] Escitalopram, marketed in different countries under different names, is a selective serotonin reuptake inhibitor antidepressant. Escitalopram is used in the treatment of depression and anxiety.

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Mindfulness meditation reduces anxiety as much as an antidepressant

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