Meditation: A Practice That Could Replace Medication for Anxiety and Excessive Worry

New research shows that "mindfulness-based stress reduction (MBSR)," a form of meditation, is as effective for people with anxiety (excessive worry and apprehension) as the antidepressant escitalopram (Cipralex, Citoles, Secita, and other brands), used as a first-line medication.

Study investigator Dr. Elizabeth A. Hoge, director of the Anxiety Disorders Research Program at Georgetown University Medical Center in Washington, said, "I recommend that doctors add meditation training to the list of possible treatments for patients diagnosed with anxiety disorders. Physicians should not hesitate to recommend in-person, group-based meditation classes."

A Very Common Problem: Anxiety

Anxiety disorders, including generalized anxiety, social anxiety, panic disorder, and agoraphobia, affect an estimated 301 million people worldwide and are the most common type of mental disorder. Because they are so prevalent, the US Preventive Services Task Force, for example, recommends screening for anxiety disorders.

Effective treatments include medication and cognitive behavioral therapies. However, not all patients can access these options, respond to them, or feel comfortable receiving treatment in a psychiatric setting. Mindfulness meditation, increasingly popular in recent years, may therefore help people experiencing frequent worry. Dr. Hoge says that by practicing mindfulness meditation, people can learn not to become caught up in these thoughts .

Relieving Anxiety Through Mindfulness Meditation

On November 9, 2022, JAMA Psychiatry published a study investigating mindfulness meditation rather than medication as a first-line option for anxiety disorders.

The study included 276 patients with anxiety disorders, mainly generalized or social anxiety. Mean age was 33; 75% were women, 59% White, 15% Black, and 20% Asian.

Researchers randomly assigned patients to two groups:

1. 136 received meditation
2. 140 received escitalopram, a selective serotonin reuptake inhibitor used as first-line medication for anxiety disorders

Meditation classes involved 2.5 hours during the week and a full weekend day. Participants also completed daily 45-minute guided meditation sessions at home and learned practices including breath awareness, body scanning, and mindful movement.

The escitalopram group initially took 10 mg orally each day. In those tolerating it well, the dose increased to 20 mg in the second week.

Initial outcomes were scored without participants' knowledge using the Clinical Global Impression of Severity (CGI-S) scale. Dr. Hoge said it measures overall symptom severity from 1 (not ill at all) to 7 (extremely ill) and can assess different anxiety disorders.

The study was completed by 208 people. The groups' CGI-S scores were:

• In the meditation group, the baseline score was 4.4, with an average improvement of 1.35 points by week 8.
• In the escitalopram group, the baseline score was 4.5, with an average improvement of 1.43 points by week 8.

Discussing the Results

Dr. Hoge said:

"What stood out was that medication worked very well, as it always does, but meditation also worked extremely well. We saw about a 30% reduction in symptoms in both groups. These findings tell us that meditation, particularly mindfulness meditation, can be useful as first-line treatment for patients with anxiety disorders."

Patient-reported results on the Overall Anxiety Severity and Impairment Scale also showed no significant group difference. Dr. Hoge said, "Having self-reports is important because it gives us two ways of looking at the information." She added that participants said meditation helped in their personal relationships and in being "kinder to themselves." These were benefits they reported.

"Meditation contains an implicit teaching to accept your thoughts without judging them, which teaches people greater self-compassion."

Just over 78% of escitalopram patients, compared with only 15% of meditation patients, experienced treatment-related adverse effects , including sleep disturbances, nausea, fatigue, and headache. Dr. Hoge said the most common adverse effect in the meditation group was anxiety, which was "counterintuitive" but represented "momentary anxiety."

"Meditation can bring up feelings people may not have noticed before, giving them an opportunity to work with those feelings."

The next most common adverse effect in meditation participants was fatigue. Dr. Hoge said this "made sense" because they put aside their stimulating phones and were no longer being stimulated.

Dr. Hoge says anyone can learn meditation, although it requires time and commitment.

Psychiatrist Dr. Gregory Scott, a faculty member at the University of Texas Dell Medical School and author of The Self-Healing Mind: An Essential Five-Step Practice for Overcoming Anxiety and Depression and Revitalizing Your Life , commented on the study: "The findings are not surprising because mindfulness, including spirituality, breathwork, and meditation, is a 'time-tested and proven' intervention. I am encouraged that studies like this are being conducted now and that more evidence supports these mindfulness-based approaches, allowing them to begin entering standard treatment guidelines. With mindfulness, "long-term, sustainable improvements" can be produced. We can say that the daily 45-minute home exercises included in the study do not take very much time when we begin considering the benefits we could gradually gain from that time."

Because most participants were women and the fact that "men are anxious too" should not be overlooked, Dr. Brown said the study should be repeated "with a more diverse participant pool."