Is mindfulness-based stress reduction noninferior to escitalopram for the treatment of adults with anxiety disorders?
This study found that standard MBSR is noninferior to pharmacotherapy with escitalopram for the treatment of adults with anxiety disorders. The primary outcome measurement occurred at 8 weeks from baseline. At 6 months, the anxiety scores remained improved, despite only 52% and 28% of the escitalopram and MBSR groups, respectively, continuing their treatments.
Randomized controlled trial (single-blinded)
Mindfulness-based stress reduction (MBSR) training is effective for decreasing anxiety symptoms in adults. It remains unclear how effective MBSR is compared with standard pharmacotherapy. These investigators identified adults, aged 18 to 75 years, 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 either MBSR training (an 8-week protocol with weekly 2.5-hour long classes, a day-long weekend retreat class, and 45-minute daily home practice exercises) or escitalopram (10 mg daily orally, increased to 20 mg daily at week 2 if tolerated). Individuals masked to treatment group assignment assessed symptom severity using a standard validated anxiety scoring tool. Follow-up occurred for 95% of participants at 8 weeks.
Using both intention-to-treat and per-protocol analyses, at the primary endpoint of 8 weeks, MBSR therapy met the criteria for noninferiority compared with escitalopram. At 6 months of follow-up, 52% of patients were still taking escitalopram while only 28% of patients were still doing regular mindfulness meditation, yet the anxiety scores remained improved.
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill