Not all people who have anxiety disorders have access to effective treatment or respond to treatment. A randomized clinical trial was undertaken to compare mindfulness-based stress reduction with escitalopram, a first-line pharmacological treatment for anxiety.

Patients 18 to 75 years of age who had a primary diagnosis of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia were eligible for the study; 208 patients were included in the final sample. Participants were randomized to eight weeks of weekly 2.5-hour mindfulness-based stress reduction classes at clinic or community sites or to escitalopram, 10 to 20 mg daily, initiated at week 2 if well tolerated.

At week 8, the mindfulness-based stress reduction group's score on the Clinical Global Impression of Severity (CGI-S) scale had improved by a mean of 1.35 points compared with 1.43 points for the escitalopram group, a nonsignificant difference indicating noninferiority of mindfulness-based stress reduction. Sensitivity analyses in the intent-to-treat sample also showed noninferiority of mindfulness-based stress reduction compared with escitalopram based on the improvement in the CGI-S score. Both groups continued to improve during the follow-up period. At least one study-related adverse event occurred in 78.6% of patients in the escitalopram group and in 15.4% of those in the mindfulness-based stress reduction group. No participants discontinued treatment because of clinical worsening or emerging suicidality.

The authors point out that patients in the mindfulness-based stress reduction group spent more time engaged in treatment-related activities than those in the escitalopram group; the participants were mostly female and relatively well educated; and mindfulness-based training was delivered in person, which limits extrapolation of the findings to other means of delivery.