Mindfulness as effective as an antidepressant for anxiety

If you have some anxiety, you are not alone. Whilst in 2022, 63.4% of adults were estimated to have no anxiety, 25.5% had low level anxiety, 7.1% medium anxiety, and 4.1% were claimed to have high anxiety.

So what to do? What does the evidence say? New research published just last month has shown a guided mindfulness-based stress reduction program was as effective for patients with anxiety disorders as the gold-standard drug - the common antidepressant escitalopram. So this week, how to apply this knowledge and details of the study itself, but first

         Thought for the day

   One forgets the self, 

   Zen teachers say, 

   By becoming one with the task at hand. 

   At such moments, 

   Released from the burdens of selfhood, 

   One glimpses, however briefly, 

   A state of spiritual wholeness that underlies 

   And supports one’s everyday consciousness.



                         Andrew Cooper

Common side effects of escitalopram are listed to include trouble sleeping, nausea, sexual dysfunction, drowsiness and feeling tired. More serious side effects may include suicidal thoughts in people up to the age of 24 years.  It is unclear if use during pregnancy or breastfeeding is safe.

Research establishes common effects of mindfulness include better sleep, good digestion (and with use of our Allwevi8 app, a specific and significant drop in nausea for those affected by it), sexual satisfaction and increased energy levels. When used during pregnancy, there is likely to be increased calm and ease in both mother and baby, and breastfeeding is likely to be facilitated for the better due to this increased calm and ease.

Of note, approximately 15% of the U.S. population tried some form of meditation in 2017.

This said, anxiety disorders can be very tough. Anxiety disorders include generalized anxiety, social anxiety, panic disorder and fear of certain places or situations, including crowds and public transportation, all of which can lead to an increased risk for suicide, disability and distress. Therefore, these disorders when severe are commonly treated in psychiatric clinics. 

In October this year, the United States Preventive Services Task Force for the first time, recommended screening for anxiety disorders due to the high prevalence of these disorders.

Drugs that are currently prescribed for the disorders can be very effective, but many patients either have difficulty getting them, do not respond to them, or find the side effects as a barrier to consistent treatment.

Elizabeth Hoge, MD, director of the Anxiety Disorders Research Program, associate professor of psychiatry at Georgetown and lead author commented:

"Our study provides evidence for clinicians, insurers, and healthcare systems to recommend, include and provide reimbursement for mindfulness-based stress reduction as an effective treatment for anxiety disorders because mindfulness meditation currently is reimbursed by very few providers." 

"A big advantage of mindfulness meditation is that it doesn't require a clinical degree to train someone to
become a mindfulness facilitator. 

Additionally, sessions can be done outside of a medical setting, such as at a school or community center."

Standardized mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR), can decrease anxiety, but prior to this study, the interventions had not been studied in comparison to effective anti-anxiety drugs. 

The clinicians recruited 276 patients between June 2018 and February 2020 from three hospitals in Boston, New York City and Washington, D.C., and randomly assigned people to either MBSR or escitalopram. MBSR was offered weekly for eight weeks via two and a half-hour in-person classes, a day-long retreat weekend class during the 5th or 6th week, and 45-minute daily home practice exercises. 

Patients' anxiety symptoms were assessed upon enrolment and again at completion of the intervention at 8 weeks, along with post-treatment assessments at 12 and 24 weeks after enrolment. The assessments were conducted in a blinded manner -- the trained clinical evaluators did not know whether the patients they were assessing received the drug or MBSR.

At the end of the trial, 102 patients had completed MBSR and 106 had completed their medication course. The patients were relatively young, with a mean age of 33 and included 156 women, which comprised 75% of the enrolees, mirroring the disease prevalence in the U.S.

The researchers used a validated assessment measure to rate the severity of symptoms of anxiety across all of the disorders using a scale of 1 to 7 (with 7 being severe anxiety). Both groups saw a reduction in their anxiety symptoms (a 1.35 point mean reduction for MBSR and 1.43 point mean reduction for the drug, which was a statistically equivalent outcome), dropping from a mean of about 4.5 for both, which translates to a significant 30% or so drop in the severity of peoples' anxiety.

"It is important to note that although mindfulness meditation works, not everyone is willing to invest the time and effort to successfully complete all of the necessary sessions and do regular home practice which enhances the effect," Hoge said. 

"Also, virtual delivery via videoconference is likely to be effective, so long as the 'live' components are retained, such as question-and-answer periods and group discussion."

Trial enrolment was wrapping up as the COVID pandemic started in early 2020 but most enrolees completed their eight-week course of treatment before the pandemic started. 

The researchers conducted a second phase of the study during the pandemic that involved moving the treatments to an online, videoconference, and that will be the focus of future analyses. The researchers also hope to explore the effects of MBSR on sleep and depression.

Reference: Hoge AE et al. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults with Anxiety Disorders. JAMA Psychiatry, 2022; DOI: 10.1001/jamapsychiatry.2022.3679

NOTE The Allevi8 app with its attendant online personalised, live mentor/teaching sessions, includes mindfulness techniques as well as meditation, contemplation, guided imagery and deep relaxation.