Mindfulness-based stress reduction noninferior to escitalopram for anxiety

Mindfulness-based stress reduction was found to be noninferior to escitalopram for the treatment of anxiety disorders, researchers reported in JAMA Psychiatry.

Elizabeth A. Hoge, MD, the director of the anxiety disorders research program at Georgetown University School of Medicine, and colleagues aimed to determine whether mindfulness-based stress reduction (MBSR) was noninferior to escitalopram, a commonly used psychopharmacological treatment for anxiety disorders.

“Mindfulness-based interventions such as MBSR can decrease anxiety but, it is unknown how they compare to standard first-line treatments,” Hoge and colleagues wrote

The researchers recruited patients for a randomized clinical trial between June 2018 and February 2020. Outcome assessments were performed by a blinded clinical interviewer at baseline, week 8, and at follow-up visits at 12 and 24 weeks.

A total of 430 individuals were assessed for inclusion. There were 276 adults diagnosed with an anxiety disorder from three urban academic medical centers in the United States, and 208 completed the trial.

Participants were randomized at a 1:1 ratio for 8 weeks and received either a weekly course of MBSR or doses of escitalopram between 10 mg and 20 mg. The primary outcome measure were anxiety levels determined with the Clinical Global Impression of Severity (CGI-S) scale.

Of the 208 participants (mean age, 33 years; 75% female) who completed the trial, 106 received escitalopram and 102 received MBSR. At baseline, CGI-S score was 4.49 for the MBSR group and 4.54 for the escitalopram group in the randomized sample.

After 8 weeks, CGI-S score was reduced by 1.35 for the MBSR group and 1.43 for the escitalopram group, with the difference between groups being –0.07 (0.16; 95% CI, –0.38 to 0.23), with the lower bound of the interval falling with the predefined noninferiority margin of –0.495, which indicated noninferiority of MBSR compared with escitalopram.

According to a secondary intent-to-treat analysis, data also showed the noninferiority of MBSR compared with escitalopram based on the improvement of CGI-S score.

“An MBSR was shown to be a well-tolerated treatment option with comparable effectiveness to a first-line medication for patients with anxiety disorders,” Hoge and colleagues wrote. “Problematic habitual thought patterns characterize anxiety disorders, and mindfulness training specifically focuses the mind on the present moment; thus, individuals practice seeing thoughts and sensations as merely transient mental phenomena and not necessarily accurate reflections of reality.”