Clinical Question

Is mindfulness-based stress reduction noninferior to escitalopram for the treatment of anxiety disorders in adults?

Bottom Line

The study findings show that standard mindfulness-based stress reduction is noninferior to pharmacotherapy with escitalopram for the treatment of anxiety disorders in adults. The primary outcome measurement occurred at eight weeks from baseline. At six months, the anxiety scores remained improved despite only 52% of the escitalopram group and 28% of the mindfulness-based stress reduction group continuing their treatments. (Level of Evidence = 1b)

Synopsis

Mindfulness-based stress reduction is effective for decreasing anxiety symptoms in adults. It remains unclear how effective this technique is compared with standard pharmacotherapy. The investigators identified adults 18 to 75 years of age with a primary diagnosis of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Eligible patients (N = 276) randomly received assignment (concealed allocation) to mindfulness-based stress reduction training (an eight-week protocol with weekly 2.5-hour-long classes, a daylong weekend retreat class, and 45-minute daily home practice exercises) or escitalopram (10 mg orally per day; increased to 20 mg per day at week 2, if tolerated). Individuals masked to treatment group assignment assessed symptom severity using a standard validated anxiety scoring tool. Follow-up occurred at eight weeks for 95% of participants.

Using intention-to-treat and per-protocol analyses at the primary endpoint of eight weeks, mindfulness-based stress reduction therapy met the criteria for noninferiority compared with escitalopram. At six months of follow-up, 52% of patients were still taking escitalopram, whereas only 28% of patients were still doing regular mindfulness meditation, but the anxiety scores remained improved.

Study design: Randomized controlled trial (single-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (any)

Reference: Hoge EA, Bui E, Mete M, et al. Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial. JAMA Psychiatry. 2023;80(1):13-21.