A randomized clinical trial found that mindfulness-based stress reduction provided similar outcomes to escitalopram for treating anxiety disorders. This secondary analysis, published in JAMA Network Open, examined patient-reported outcomes and disorder-specific clinician measures.
The study, conducted at Georgetown University Medical Center, included 276 adults with diagnosed anxiety disorders. Participants underwent either eight weeks of mindfulness-based stress reduction or received flexibly dosed escitalopram (10-20 mg/day).
Key findings:
- No significant differences in anxiety symptoms were found between the mindfulness-based stress reduction (MBSR) and escitalopram groups at the primary endpoint (week 8).
- Effect sizes for between-group differences were small (Cohen d = 0.01-0.20) and not clinically meaningful.
- At midtreatment (week 4), escitalopram showed greater improvement in PROMIS Anxiety and Depression scores, but differences were no longer significant by week 8.
- Adverse events were reported by 78.6% of escitalopram recipients vs 15.4% of MBSR participants (P < .001).
Study Details:
The trial included adults with a primary anxiety disorder, such as generalized anxiety disorder, panic disorder, agoraphobia, or social anxiety disorder. The MBSR group attended weekly classes focused on mindfulness meditation practices, while the escitalopram group met with prescribers at regular intervals for medication management.
Outcomes were assessed using both patient-reported and clinician-rated measures, including:
- Beck Anxiety Inventory (BAI)
- PROMIS Anxiety and Depression scales
- Penn State Worry Questionnaire
- Liebowitz Social Anxiety Scale
- Panic Disorder Severity Scale
- Structured Interview Guide for the Hamilton Anxiety Scale
- PROMIS quality of life and role functioning scales
Linear mixed models were used to compare groups, adjusting for demographic factors, baseline anxiety severity, and study site.
Limitations:
The study authors noted that participants in the MBSR group had more face-to-face time with their instructors compared to those in the escitalopram group. Additionally, the study’s sample size limited the ability to perform noninferiority testing for multiple secondary outcomes.
The findings suggest similar efficacy between MBSR and escitalopram in treating anxiety disorders, with MBSR associated with fewer adverse events.
Conflict of interest disclosures can be found in the original research letter.
