Mindfulness Stress Reduction vs Escitalopram Equal in Patient-Reported Anxiety

No clinically meaningful differences in effectiveness exist between mindfulness-based stress reduction (MBSR) and escitalopram in anxiety and depression, according to the study findings in a research letter published in JAMA Network Open.

In the letter, researchers presented secondary outcomes (patient-reported anxiety, depression, quality-of-life [QOL]) from a noninferiority trial between 8 weeks of MBSR and pharmacotherapy.

In the current study, the researchers conducted a secondary analysis of a multicenter, parallel-group, evaluator-blinded, randomized clinical trial (NCT03522844) among community-dwelling adults with a clinically diagnosed primary anxiety disorder (generalized anxiety, panic, agoraphobia, social anxiety disorder). In the trial, participants were randomly assigned 1:1 to MBSR (weekly classes including theory and practice of several forms of mindfulness meditation) or escitalopram (flexibly dosed [10-20mg/d].

The blinded-evaluators assessed anxiety at baseline, the primary endpoint (week 8), and in follow-up (weeks 12 and 24) using the patient-reported Beck Anxiety Inventory (BAI), PROMIS Anxiety Short Form, and the Penn State Worry Questionnaire and clinician-reported Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale, and the Structured Interview Guide for the Hamilton Anxiety Scale. The PROMIS Satisfaction with Participation in Social Roles and the PROMIS Ability to Participate in Social Roles and Activities scales were used to evaluate QOL; the PROMIS Depression scale was used to evaluate depression symptoms.

Overall, 276 participants were included in analysis (mean [SD] age, 33 [13] years; 75% women; self-reported 60% White, 19% Asian, 15% Black, 9% Hispanic, 6% other race/ethnicity). Other than the BAI scores (between-group comparison P=.05), no significant between-group differences were noted in baseline outcome measures or demographic characteristics.

The researchers found reductions in anxiety symptoms in both groups with between-group differences equating to small effect sizes (Cohen d≤0.20). At the primary endpoint (week 8), between-group estimated mean differences showed no significant difference, although at mid-treatment (week 4), escitalopram showed significantly greater improvement in the PROMIS Anxiety and PROMIS Depression scores, both no longer significant at week 8.

Additionally, 78.6% of the escitalopram group reported at least 1 treatment-related adverse event vs 15.4% of MBSR participants.

Study limitations include more face-to-face time with their meditation instructor and prescriber among MBSR recipients vs escitalopram recipients.

The study authors wrote, “Taken together (these results along with the noninferiority results), these findings support clinical application of MBSR to treat anxiety disorders, with outcomes similar to antidepressant pharmacotherapy but with potentially fewer side effects.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor