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.