Comparing Meditation versus Medicine for Patients with Anxiety Disorders

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What was the research about?

People with anxiety disorders may feel fear, worry, or nervousness. These feelings can make doing daily activities hard. Certain medicines can help reduce anxiety, but people may have side effects or other problems taking them. Meditation can also help reduce anxiety.

In this project, the research team compared two treatments for patients with anxiety disorders:

• Mindfulness-based stress reduction, or MBSR. MBSR is a type of meditation. Patients took an MBSR course for eight weeks. They learned about different forms of MBSR and how to practice meditation. They also received guided practice sessions on meditation for home use.
• Escitalopram, a medicine for anxiety. Doctors prescribed this medicine for eight weeks. Patients took 10 milligrams (mg) per day by mouth during week one. Doctors increased the dose to 20 mg per day during week two if the patient didn’t have bad side effects.

The research team first wanted to learn if MBSR wasn’t worse than the medicine in reducing anxiety. The team also compared MBSR delivered in person before the COVID-19 pandemic with MBSR delivered online during the pandemic.

What were the results?

After eight weeks, when delivered in person, MBSR worked about the same as the medicine to reduce anxiety symptoms. Both treatments reduced patients’ anxiety symptoms. Also, online MBSR worked about the same as in-person MBSR.

Among patients who received the medicine, 79 percent had at least one side effect compared with 15 percent of patients who received MBSR. The most common side effects for the medicine were insomnia or sleep disturbances, nausea, and fatigue. The most common side effect for MBSR was increased anxiety during treatment.

Who was in the study?

The in-person study included 208 patients, and the online study included 197 patients. Patients had different types of anxiety, including general, social, panic attacks, or fear of crowds. Among patients, 59 percent were White, 20 percent were Asian, 16 percent were Black, and 7 percent were another race; 9 percent were Hispanic or Latino. The average age was 34, and 76 percent were women. All received care at one of three health centers in Washington, DC, New York City, and Boston.

What did the research team do?

The research team assigned patients by chance to receive MBSR or the medicine. Patients had regular check-ins with a clinician, such as a doctor or nurse, during the study. During the pandemic, the team repeated the study and delivered treatments online.

At four and eight weeks, an independent clinician assessed patients’ anxiety symptoms. The clinician didn’t know which treatment patients received.

Patients with anxiety disorders, clinicians, a healthcare system representative, and an anxiety disorder outreach organization helped design the study.

What were the limits of the study?

Most patients in the study were women and had a college degree. Results may differ for patients of other backgrounds.

Future research could include patients of other backgrounds.

How can people use the results?

Doctors and patients can use the results when considering treatments for anxiety disorders.

Objective

To compare the effectiveness of mindfulness-based stress reduction (MBSR) versus escitalopram in reducing anxiety symptoms among patients with an anxiety disorder

Study Design

This randomized controlled non-inferiority trial compared the effectiveness of MBSR and escitalopram in reducing anxiety symptoms among patients with an anxiety disorder, including generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia.

Researchers randomly assigned 208 patients to one of two in-person treatments:

• MBSR. Patients received a group-based course about mindfulness meditation for eight weeks. Patients learned about different forms of mindfulness and how to practice mindfulness meditation. Patients also received audio-recorded guided practice sessions on meditation for home use.
• Escitalopram. Patients self-administered escitalopram for eight weeks; they took 10 milligrams (mg)/day orally during week one and, if well tolerated, increased dosage to 20 mg/day during week two.

During the COVID-19 pandemic, researchers repeated the study, randomizing 167 patients to online treatment delivery. They compared in-person delivery of MBSR before the pandemic with online delivery during the pandemic; this study included 197 patients.

Patients received care at one of three urban medical centers in Washington, DC, New York City, and Boston. Among patients, 59% were White, 20% were Asian, 16% were Black, and 7% were another race; 9% were Hispanic or Latino. The average age was 34, and 76% were female.

Patients had check-ins with a clinician about anxiety symptoms during the first eight weeks of treatment. Independent clinical evaluators blinded to treatment assessed patients’ anxiety symptom severity at baseline and four and eight weeks later.

Patients with an anxiety disorder, clinicians, a healthcare system representative, and an anxiety disorder outreach organization helped design the study.

Results

At eight weeks, in-person MBSR was statistically non-inferior to escitalopram in reducing anxiety (p=0.65; 95% confidence interval [CI]: -0.38, 0.23). Patients who received MBSR and patients who received escitalopram had reductions in anxiety symptoms. Online MBSR was non-inferior to in-person MBSR (p=0.4; 95% CI: -0.33, 0.25).

When comparing MBSR delivered online and escitalopram prescribed online, the results were inconclusive. Although both treatments reduced anxiety symptoms, the amount of difference between the two treatments did not indicate that MBSR delivered online was non-inferior to escitalopram prescribed online.

Among patients who received escitalopram, 79% had at least one study-related adverse event compared with 15% of patients who received MBSR. The most common adverse events for escitalopram were insomnia or sleep disturbance, nausea, and fatigue. The most common adverse event for MBSR was increased anxiety during treatment.

Limitations

Most patients in the study were female and had a college degree. Results may differ among patients of other backgrounds. For the comparison of online versus in-person MBSR, the study did not randomize patients, which limits the ability to draw conclusions about non-inferiority.

Conclusions and Relevance

In this study, when delivered in person, MBSR was not worse than escitalopram in reducing anxiety symptoms among patients. MBSR delivered online was not worse than MBSR delivered in person.

Future Research Needs

Future research could compare MBSR and escitalopram among patients of other backgrounds.