MBSR vs. Lexapro - a study

A wonderful study came out a couple of years ago, and I recently had the opportunity to read it and dig a little deeper than the press releases that were in the media at the time. The study, titled "Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders," by Elizabeth A. Hoge, MD, et. al., was originally published in 2022 in JAMA Psychiatry. It compares about 270 volunteers who were randomly assigned to one of two groups: one that received the standard treatment of escitalopram (brand name Lexapro), and one that attended an 8-week MBSR course. All participants had a clinical diagnosis of an anxiety disorder. Outcomes were assessed at 4 weeks, 8 weeks, 12 weeks, and 24 weeks.

The result is pretty exciting for me as a mindfulness teacher: "... this randomized clinical trial comparing a standardized evidence-based mindfulness-based intervention with parmacotherapy for the treatment of anxiety disorders found that MBSR was noninferior to [i.e. as efficacious as] escitalopram." (!)

It is important to note that for both groups, the improvement in mood was modest, about 4.5 points on the Clinical Global Impressions Scale, a standardized tool widely used in medical settings to assess mental wellbeing during clinical trials. However, while modest, this improvement was meaningful and statistically significant!

Having seen a family member go treatment for anxiety and depression, my impression has been that psychotropic drug treatment tends to be somewhat hit or miss. In my family member's case, some drugs did nothing at all, some made things worse, and some actually helped. So even a modest improvement is certainly a win!

Another detail to note is that all drugs can and do have side effects. In this study, while few serious adverse events occurred in either group, more unpleasant side effects were reported for escitalopram than for MBSR. You might wonder why there were any negative side effects for MBSR: The main one was increased anxiety, especially around week 4. By week 8 (i.e. the end of the MBSR program), the two groups reported the same (improved) level of anxiety, and this held true through the end of the study.

In conclusion and to quote the authors, "MBSR was shown to be a well-tolerated treatment option with comparable effectiveness to a first-line medication for patients with anxiety disorders."

I do not mean to imply that there is anything wrong with psychopharmaca. In fact, the experience with my family member has made me very grateful for anything that offers relief. I just think it's wonderful that other treatment modalities are being explored by the scientific community, which may lead to alternative treatments being offered more frequently.

One thing that hasn't yet been investigated, as far as I know, is whether the outcomes would be even better by combining excitalopram and mindfulness. Intuitively one would have to assume that the answer is yes... but it remains to be seen.