5MinuteConsult Journal Club
Curing Anxiety, Not Just Treating It
JAMA Psychiatry. 2023;80(1):13-21. doi:10.1001/jamapsychiatry.2022.3679
Randomized controlled trial of 276 adults with anxiety (Treatments for Anxiety: Meditation and Escitalopram [TAME]) used a noninferiority design to determine if an 8-week treatment with mindfulness-based stress reduction was non-inferior to escitalopram (10-20 mg). The primary outcome was assessed with the Clinical Global Impression of Severity scale (CGI-S).
At 8 weeks, the mean (SD) CGI-S score was reduced by 1.35 (1.06) for MBSR and 1.43 (1.17) for escitalopram; mean difference between the interventions was −0.07 (0.16; 95% CI, −0.38 to 0.23; P = .65) a non-inferior difference.
Of patients who started treatment, 10 (8%) dropped out of the escitalopram group and none from the MBSR group due to adverse events.
For generalized anxiety, mindfulness-based stress reduction meditation was as effective as up to 20 mgs of escitalopram, with fewer dropouts.
This shows treatment non-inferiority between a medication and mindfulness stress reduction for anxiety over 8 weeks. So why entitle this blog as curing vs treating?
SSRIs are effective at controlling anxiety and depression but have high relapse rates. A recent BMJ meta-analysis suggests the risk for relapse is tripled after stopping medication (https://www.bmj.com/content/358/bmj.j3927).
Medications help the brain when in your system, but with no new compensatory skills, patients often revert to their previous altered coping and resulting anxiety. Meditation teaches the brain a new skill to address anxiety when it arises and prevents it over the long term.
This site (https://positivepsychology.com/mindfulness-based-stress-reduction-mbsr/) is an easy place to offer patients, as it has 3 free downloads for them to try before investing any money. Apps that are highly rated for addressing anxiety include MindShift CBT and Insight Timer.
Before you write another SSRI or benzo for your patients with GAD, consider offering them a lifelong solution.
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Patient Education: Meditation; Algorithm: Anxiety
Contributed by Frank J. Domino, February 1, 2023