When anxiety is bad enough to disrupt daily life, a mindfulness-based stress reduction course is not worse than a commonly used anti-anxiety drug

For people diagnosed with an anxiety disorder, an 8-week mindfulness-based stress reduction course improves symptoms almost as much as the anti-anxiety drug escitalopram. Nearly 80% of the people on the drug had an adverse reaction, and some quit because of it. About 15% of the people in the course had an adverse reaction, and nobody quit. The course has to be a standardized 8-week course. A random meditation app does not count.

Cost

Signing up for the course costs a bit of money. The course runs 8 weeks, with 1 class a week, plus daily practice at home. The hard part is practicing every day for 8 weeks straight.

Benefit

This trial was done at 3 urban academic medical centers in the United States, to see whether the course would be worse than the drug (a non-inferiority randomized controlled trial). 276 adults diagnosed with an anxiety disorder were split at random 1:1. The course group took an 8-week mindfulness-based stress reduction course. The drug group took escitalopram (a flexible dose of 10 to 20 mg). 208 people finished the whole course. At the end, scored on the anxiety severity rating given by a clinician (the Clinical Global Impression–Severity scale), the mindfulness group fell by 1.35 and the drug group fell by 1.43. The difference between the groups was −0.07 (95% CI −0.38 to 0.23, meaning the true gap falls roughly in this range; P=0.65, meaning this gap cannot be told apart from no difference). The lower end of this range did not cross the line drawn in advance for "not counting as worse" (non-inferiority margin −0.495). Side effects differed a lot: 78.6% of the drug group had at least 1 trial-related adverse reaction, and 10 people quit because of it. The mindfulness group was 15.4%, and nobody quit because of it.

Notes

The trial used a standardized 8-week mindfulness-based stress reduction course (MBSR). A random meditation app cannot be treated as the same thing. It applies to people who already meet the diagnostic criteria for an anxiety disorder. If you should see a doctor, see a doctor. If you have been putting off treatment because you worry about drug side effects, there is another option with evidence of similar strength.

Sources · 1

1. Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM (2023). Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 80(1), 13-21. doi.org/10.1001/jamapsychiatry.2022.3679