The following is a summary of “Mindfulness-Based Stress Reduction vs. Escitalopram for the Treatment of Adults With Anxiety Disorders,” published in the November 2022 issue of Psychiatry by Hoge, et al.

Common, extremely upsetting, and negatively affecting illnesses include anxiety disorders. There were efficient therapies available, yet many people did not use or benefit from them. It was uncertain how mindfulness-based therapies, such as mindfulness-based stress reduction (MBSR), compared to conventional first-line treatments even though they are well-liked and can reduce anxiety. For a study, researchers sought to ascertain if escitalopram, a popular first-line psychopharmacological therapy for anxiety disorders, was non-inferior to MBSR.

The noninferiority design of the randomized clinical trial (Treatments for Anxiety: Meditation and Escitalopram [TAME]) included a predetermined noninferiority margin. During the period of June 2018 to February 2020, patients were recruited. A blinded clinical interviewer carried out the outcome evaluations at the baseline visit, the week 8 endpoint, and the follow-up visits at 12 and 24 weeks. Of the 430 people who were evaluated for inclusion, 276 adults from three metropolitan academic medical facilities in the US who had been diagnosed with an anxiety condition were recruited for the experiment, and 208 of them finished it. The antidepressant escitalopram, with flexible doses ranging from 10 to 20 mg, or the monthly MBSR course, were given equal odds of success to participants. The Clinical Global Impression of Severity scale (CGI-S), with a preset noninferiority margin of -0.495 points, was used to quantify anxiety levels as the main outcome.

With a mean (SD) age of 33 (13) years, the primary noninferiority sample included 208 patients (102 in MBSR and 106 in escitalopram); 156 participants (75%) were female; 32 participants (15%) were African American; 41 participants (20%) were Asian; 18 participants (9%) were Hispanic/Latino; 122 participants (59%) were White; and 13 participants (6%) were of another race or ethnicity (including Native American or Alaska Native, more than one race, or other, consolidated owing to low numbers). In the per-protocol sample and the randomized sample, the baseline means (SD) CGI-S scores were 4.44 (0.79) for the MBSR group and 4.51 (0.78) for the escitalopram group, respectively. At the endpoint, the mean (SD) CGI-S score for MBSR and escitalopram decreased by 1.35 (1.06) and 1.43 (1.17), respectively. The difference between the groups was 0.07 (0.16; 95% CI, -0.38 to 0.23; P =.65), and since the lower bound of the interval was within the predetermined noninferiority margin of -0.495, it indicated that MBSR was superior than escitalopram in the comparison. Based on the increase in CGI-S score, secondary intent-to-treat analyses with imputed data similarly demonstrated the noninferiority of MBSR compared to escitalopram. Ten (8%) of the patients who began therapy discontinued it owing to adverse events in the escitalopram group but none in the MBSR group. For 110 individuals randomly assigned to escitalopram (78.6%) and 21 persons randomly assigned to MBSR (15.4%), at least 1 study-related adverse event occurred.

MBSR was shown to be noninferior to escitalopram in the randomized clinical study that compared a structured, scientifically-supported mindfulness-based intervention with medication for the treatment of anxiety disorders.