Trending Clinical Topic: Meditation vs Medication

Ryan Syrek


November 25, 2022

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Evidence supporting the potential for meditation to produce significant health results continues to stack up. Several recent studies compared the efficacy of mindfulness and related strategies vs pharmaceutical interventions in various conditions. The results sparked a great deal of interest, perhaps most notably those from a trial of mindfulness-based stress reduction (MBSR) in patients with anxiety disorders (see Infographic).

The study included 276 adult patients, most of whom had generalized anxiety or social anxiety. The mean age was 33 years; 75% were women, 59% were White, 15% were Black, and 20% were Asian. Participants were randomly assigned to receive MBSR (136 patients) or escitalopram (140 patients). MBSR included a weekly 2.5-hour class, a day-long weekend class, and daily 45-minute guided meditation sessions at home. The primary outcome was the score on the Clinical Global Impression–Severity (CGI-S) scale for anxiety. Among the 208 participants who completed the study, the baseline mean CGI-S score was 4.44 for MBSR and 4.51 for escitalopram. At week 8, the MBSR group's score improved by a mean of 1.35 points, whereas the escitalopram group's score improved by 1.43 points (difference, -0.07; 95% CI, -0.38 to 0.23; P = .65). The lower end of the CI (-0.38) was smaller than the prespecified noninferiority margin of -0.495, indicating noninferiority. Around 78% of those receiving escitalopram had at least one treatment-related adverse event, compared with 15.4% in the MBSR group.

Another recent study examined the effect of mind-body practices, including yoga and meditation, on patients with type 2 diabetes. The meta-analysis included 28 studies involving patients with type 2 diabetes published between 1993 and 2022. Findings suggest that mindfulness modalities improved glycemic control to a similar extent as medications such as metformin. Across all types of mindfulness interventions, a significant mean reduction in A1c of 0.84% was observed (P < .0001). With MBSR, A1c was reduced by 0.48% (P = 0.03). With meditation specifically, A1c dropped by 0.50% (P = .64). The largest drop in A1c was associated with yoga, where it fell by 1.00% (P < .0001); that is approximately the same degree of glycemic control achieved with metformin, the authors suggest.

MBSR has also recently proven effective against pain. In a randomized trial, more than 100 healthy individuals were assigned to an 8-week MBSR program, an 8-week health improvement program (HEP), or a waiting list. To examine the interventions' effect on the pain experience, participants underwent a pain task. They had 20 thermal stimuli applied to the wrist for 12 seconds, including 8 seconds at peak temperature. During the task, participants underwent MRI to assess the neurologic pain signature (NPS) and the stimulus intensity independent pain signature-1 (SIIPS-1) within the brain. The MBSR group had a significant decrease in NPS compared with the HEP group (P = .05) and from pre- to postintervention assessments (P = .023). Those in the MBSR group also had "marginal" NPS decreases vs the waiting list group (P = .096) and in SIIPS-1 compared with both the HEP (P = .089) and waiting-list groups (P = .087). In subjective pain ratings, the MBSR group had a marginal decrease compared with the waiting-list group (P = .078) and from pre-to postintervention assessments (P = .028). Long-term meditators reported significantly less pain intensity and unpleasantness (P < .001).

From pain to glucose control to anxiety disorders, the potential of meditation and related interventions to produce results similar to those of pharmaceutical interventions has certainly caught the eye of many clinicians. These three recent findings in particular were of interest to those comparing meditation with medication, leading to this week's top trending clinical topic.

Take a quick quiz about key recent findings related to anxiety.


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