Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyJanuary/February 2023
In a randomised trial, mindfulness stress-reduction classes were as effective as antianxiety medication.
Anxiety disorders are often seen in primary care and can affect the presentation and course of common medical illnesses. In this eight week, multicentre, randomised USA trial, mindfulness-based stress reduction (MBSR) was compared with escitalopram (10 to 20 mg daily) in 276 patients with generalised, social and panic anxiety. MBSR consisted of weekly 2.5 hour classes focused on meditative breathing, body awareness and mindful movement, with daily home practice.
Both treatments lowered baseline anxiety from the marked range to the mild range, with no significant difference between treatments. On a seven-point anxiety severity scale, average scores decreased from about 4.5 to 2.9 points in both groups at 24 weeks. Adverse effects (e.g. headache, fatigue, nausea, insomnia) were much more prevalent in the escitalopram group but generally were rated as ‘mild’.
Comment: As a psychiatrist who specialises in anxiety, I know that nonmedication treatments such as cognitive behavioural therapy (CBT) are highly effective and often are preferable to medication as initial treatment. Unfortunately, CBT and related psychotherapies can be hard to access, leading to overreliance on medication. MBSR-related therapies are different: They are taught in classes by approved practitioners who do not require psychotherapy licensing. Classes can be accessed easily through local adult education programs, and the acquired skills can be practiced at home. If I were a primary care doctor, I would tell patients with anxiety disorders that, although I could provide medication, they also could sign up for one of these educational classes. The current study suggests that their anxiety would improve with classes as much as with medication. Finally, Internet-based classes similar to the one studied here are available but have not been compared rigorously with in-person classes.
PETER ROY-BYRNE, MD
Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA.
Hoge EA, et al. Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial. JAMA Psychiatry 2023; 80: 13-21.
This summary is taken from the following Journal Watch title: Psychiatry