Mindfulness programme as effective as escitalopram in treating anxiety

Mindfulness-based stress reduction (MBSR) course is safe and as effective as first-line escitalopram for treatment of anxiety disorders, a randomized control trial has shown.

“Anxiety disorders are common, highly distressing and impairing conditions. Effective treatments exist, but many patients do not access or respond to them,” wrote the researchers. “Mindfulness-based interventions, such as MBSR, are popular and can decrease anxiety, but it is unknown how they compare with standard first-line treatments.”

The researchers recruited 276 patients with a current primary diagnosis of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia (mean age, 33 years; female, 75 percent) from three hospitals in the US between June 2018 and February 2020. Participants were randomized to either receive escitalopram (10 mg QD, increasing to 20 mg QD at week 2 if tolerated) or undertake an MSBR programme (consisting of several forms of mindfulness meditation such as breath awareness, body scan and mindful movement) for 8 weeks. [JAMA Psychiatry 2022;doi:10.1001/jamapsychiatry.2022.3679]

At week 8, the mean Clinical Global Impressions Scale (CGI-S) score was reduced by 1.35 points in the MBSR group and by 1.43 points in the escitalopram group (difference, -0.07; 95 percent confidence interval [CI], -0.38 to 0.23; p=0.65). “The CI crossed zero, suggesting that the change was not significantly different between the groups,” commented the researchers. “The lower bound of the interval fell within the predefined noninferiority margin of −0.495, indicating noninferiority of MBSR compared with escitalopram.”

“Problematic habitual thought patterns characterize anxiety disorders. Mindfulness training specifically focuses the mind on the present moment,” noted the researchers. “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, and individuals become less reactive to thoughts and sensations.”

Notably, adverse events (AE) incidence was significantly higher in the escitalopram group vs the MBSR group (78.6 percent vs 15.4 percent; p<0.001).

AEs occurring in ≥5 percent of escitalopram-treated participants were insomnia or sleep disturbance, nausea, fatigue, headache, somnolence, anorgasmia or delayed orgasm, abnormal dreaming, decreased appetite, jitteriness, decreased libido, dizziness/light-headedness/fainting, increased sweating and anxiety (5–41 percent).

“The only AE that occurred in ≥5 percent of participants in the MBSR group was increased anxiety [11 percent],” noted the researchers.

In addition, no participants discontinued due to clinical worsening or emerging suicidality, and no serious AEs occurred during the study in both groups.

“MBSR was shown to be a well-tolerated treatment option with effectiveness comparable to a first-line medication [escitalopram] for patients with anxiety disorders,” concluded the researchers.