Meditation or Medication for Anxiety Treatment: Is One Better Than the Other?

Summary: We review the results of the first randomized controlled study designed to compare outcomes on the effect of meditation or medication for anxiety treatment.

Key Points:

• Meditation is noninferior to medication – meaning as good as medication – for reducing symptoms of anxiety
• Symptom reduction lasted at least 6 months post-treatment
• Interesting findings on in-person vs. virtual treatment

New Developments in Anxiety Treatment: Meditation and Mindfulness

Over the past two decades, mental health treatment has changed in a variety of ways. Alongside a gradual nationwide decrease in stigma and increase in awareness around mental health, mental health disorders, and treatment for mental health disorders, many patients and providers are exploring new approaches to treatment, including the use of mindfulness-based meditation – in addition to, and sometimes instead of – typical, traditional. first-line medications for anxiety.

Research like this is an essential component of public health and wellness. Leading up to the coronavirus pandemic, mental health professionals raised the alarm about increases in several mental health diagnoses in the U.S., with two specific phenomena causing significant concern:

• Increases in suicidality among young people
• Increases in anxiety and depression across adult age groups

In this article, we’ll share data from the study “Comparing Meditation versus Medicine for Patients with Anxiety Disorders,” which analyzed the impact of meditation, in the form of mindfulness-based stress reduction (MBSR), and medication, in the form of the antidepressant medication escitalopram, on symptoms of the following anxiety disorders:

• Generalized anxiety disorder (GAD)
• Panic disorder (PD)
• Agoraphobia
• Social anxiety disorder (SAD)

Here’s something people who don’t have anxiety, or have had no real contact with people who have a clinical anxiety disorder, should understand:

When left untreated, the symptoms of an anxiety disorder can create serious disruption in all areas of life.

In some cases, mild anxiety symptoms may cause minimal disturbance, and patients can learn to manage symptoms effectively with a traditional combination of therapy and medication. However, in other cases, patients with moderate to severe anxiety report significant disruption in family relationships, peer and/or romantic relationships, work, school, and social life.

But how many people in the U.S. have anxiety? Is it really a big problem?

Anxiety Disorders: The Latest Facts and Figures

Let’s take a look the research on the prevalence of anxiety among adults in the U.S. First, a study published in 2020 that identified trends in past-month anxiety among adults, based on data collected between 2008 and 20018.

Past-Month Anxiety 2008-2018: Trends for Adults 18+

• Any anxiety diagnosis:
  • 2008: 5.12%
  • 2018: 6.68%

Next, we’ll look at past-two-week anxiety prevalence among adults, as reported by the Centers for Disease Control (CDC):

Past Two-Week Anxiety 2019: Adults 18+

• Any Anxiety: 15.6%
  • Mild Anxiety: 9.6%
  • Moderate Anxiety: 3.4%
  • Severe Anxiety: 2.7%

Next, the results of research conducted by The Healthy Minds Network between 2020 and 2023:

Past Two-Week Anxiety: Young Adults 18-30

(See the research here, here, and here)

• 2020/2021:
  • Total: 34%
    • Mild/moderate: 18%
    • Severe: 16-17%
• 2022-2023:
  • • Total: 36%
      • Moderate: 19%
      • Severe: 17%

Yes: anxiety is, indeed, a big problem in the U.S. The facts show that millions of people have clinical anxiety disorders and need evidence-based treatment to help them rediscover balance, manage their symptoms, and regain control over their lives.

Let’s look at the study we mention above, and learn more about how meditation can help the millions of patients with anxiety who need professional treatment and support.

About the Study: Methods and Measures

To assess the impact of meditation and medication on anxiety, the research team recruited a total of 208 patients, 77 percent female, average age 33, all with a previous diagnosis of generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia, and/or social anxiety disorder (SAD), and divided them into two groups:

1. The MBSR This group received 8 weeks of mindfulness meditation treatment, which included:

• One 2.5-hour session per week
• One full Saturday workshop after week 6
• Follow up assessments at 8, 12, and 24 weeks

2. The escitalopram This group received 8 weeks of weekly medication management to assess:
   • Treatment adherence, buy pill count
   • Side-effect complications, by patient report
   • Treatment progress, by primary and secondary outcome assessments administered at weeks 1,2,4,6, and the end point of the study, week 8.
   • Follow up assessments at weeks 12 and 24

Researchers divided each group further, creating both an in-person group and a virtual group for patients receiving MBSR and patients receiving escitalopram. For all patients, the primary outcome was reduction of symptoms as measured by the Clinician Global Severity Scale (CGI-S), an evidence-based assessment that, according to reliable search, “correlates with anxiety and depression scales across disorders.” Researchers assessed secondary outcomes for mental health and quality of life with the following tools:

1. Clinician Global Improvement Scale (CGI-Improvement)
2. Patient-Recorded Outcomes Measurement Information System for Anxiety (PROMIS-Anxiety)
3. Beck Anxiety Inventory
4. Overall Anxiety Severity and Impairment Scale
5. Penn State Worry Questionnaire
6. Liebowitz Social Anxiety Scale
7. Panic Disorder Severity Scale
8. Satisfaction with Participation in Social Roles
9. Structured Interview Guide for the Hamilton Anxiety Scale (SIGH-A)
10. PROMIS Ability to Participate in Social Roles and Activities Scale

Let’s look at what they found.

What’s Better for Anxiety? Meditation or Medication?

The primary goal of the study was to determine whether meditation was as effective as medication for reducing anxiety symptoms. Here’s the data:

Goal 1: Meditation or Medication for Anxiety Treatment

Treatment end point (8 weeks):

• MBSR: CGIS decreased by 1.35 points
• Escitalopram: CGIS decreased by 1.43 points for escitalopram

12-week follow-up:

• MBSR: CGIS decreased by 2.89 points
• Escitalopram: CGIS decreased by 2.95 points

24-week follow-up:

• MBSR: CGIS decreased by 2.92 points
• Escitalopram: CGIS decreased by 2.92 points

Analysis:

MBSR confirmed as noninferior to escitalopram for reduction of anxiety symptoms at treatment end point and at 12- and 24-week follow-up. In addition, data showed any differences between MBSR and escitalopram disappeared by week 12 on all the following secondary outcome measures.

The second goal of the study was to identify any difference in the effect of MBSR delivered online vs. MBSR delivered in-person.

Goal 2: Online MBSR or In-Person MBSR

At treatment end point (8 weeks):

• Online MBSR:
  • CGIS score: 3.0
• In-person MBSR:
  • CGIS score: 3.1

Analysis:

Online MBSR confirmed as non-inferior to in-person MBSR.

The third and final goal was to identify any difference between MBSR delivered and escitalopram delivered online. Here’s what they found:

Goal 3: Online MBSR or Escitalopram Prescribed Online

At treatment end point:

• Online MBSR:
  • CGIS improved by 1.29 points
• Escitalopram Prescribed Online:
  • CGIS improved by 1.51

Analysis:

Inconclusive.

MBSR falls 0.027 points outside the margin of error allowed for noninferiority compared to escitalopram.

 

While the researchers indicate this is an inconclusive result, the figures themselves reveal online escitalopram as superior to online MBSR, but by an extremely narrow margin: less than a third of a percentage point.

We’ll discuss these results below.

How Does This Information Help?

Given the increasing rates of anxiety in the U.S. over the past two decades, the results of this study help patients in the following ways:

1. They indicate MBSR is an effective therapeutic approach for reducing symptoms of anxiety.
2. They show MBSR is noninferior, or in common language at least as good as a standard, first line antidepressant medication typically prescribed for anxiety.
3. MBSR delivered online is noninferior to MBSR delivered in person.

For people with anxiety, these outcomes have real meaning.

First, for patients interested in non-pharmacological approach to anxiety treatment, this study shows MBSR can reduce their symptoms of anxiety. Second, some patients are open to pharmacological treatment but experience negative side effects when taking escitalopram: this study confirms that with MBSR, these patients can receive effective treatment without risk of negative side-effects associated with antidepressant medication. Third, it shows that for patients who prefer online treatment to in-person treatment, online MBSR is noninferior to in-person MBSR.

In summary, this new research confirms the validity of new therapeutic approaches for patients with anxiety. With the addition of in-person or online MBSR to the existing array of treatment options, providers can expand access to treatment and offer effective, evidence-based support to more patients than ever before.