Mindful Meditation vs Medication - What's Best?

A 2022 peer reviewed study was the first randomised clinical trial (RCT) to compare the effectiveness of mindfulness meditation with the anti-depressant drug escitalopram.

The study conducted by researchers at Georgetown University Medical Center concluded that mindfulness meditation was as effective as the commonly prescribed anti-depressant escitalopram (Cipralex / Lexapro) in reducing anxiety after 8 weeks.

How do the results of this study help with reducing pain and recovering from injury?

Pain is a complex, multi-factor phenomenon - read the blog post "Why Doesn't Pain Just Go Away" (link to the article at the bottom of this post).

Strong emotions like anxiety increase pain on several levels:

• Tissue: Muscles tense up to guard and protect you from injury or threat, real or perceived
• Beliefs: Catastrophising - believing that your body is weak or that certain movements will injure you - also makes muscles guard and tense
• Physiology: Anxiety increases stress in the body and reduces your resilience to stressful events. This triggers and potentially prolongs the stress response of adrenaline, noradrenaline and cortisol which fans the flames of inflammation. Inflammation leads to pain, resulting in more anxiety.

Therefore anything that effectively helps to reduce your anxiety will be of benefit in finding lasting relief from pain.

The Study

The study was conducted by researchers at Georgetown University Medical Center, and the results published in JAMA Psychiatry, a peer reviewed journal.

It was the first randomised clinical trial (RCT) to compare the effectiveness of a course of mindfulness meditation with the commonly prescribed anti-depressant escitalopram (Cipralex / Lexapro).

RCT's are considered the gold standard of clinical trials as they are designed to remove bias from data collection, so the results should be more objective and accurate.

The adult participants were divided into 2x groups:

• 102 patients in the mindfulness group
• 106 patients in the anti-depressant group

1) Team Mindfulness 

The mindfulness group practiced a technique called Mindfulness-Based Stress Reduction (MBSR). They meditated daily for 45 minutes using techniques they learned at weekly classes, including body scanning, breath awareness and mindful movement. They also attended day long weekend retreats.

2) Team Medication

This group received 10mg escitalopram daily in week 1. If they tolerated the pill well they took 20 mg daily for the rest of the 8 week study.

At the end of the 8 week trial Team Mindfulness saw their anxiety symptoms improve almost as much as Team Medication. The researchers concluded that mindfulness meditation was NOT inferior to medication.

Please note that there were 4x comments from fellow researchers and health professionals regarding the methodology, results and conclusions drawn from this study. It's always worth reading these and then use your own critical thinking to evaluate whether you believe this trial is valid and useful.

I agree with one of the comments that it would have been interesting to continue the trial beyond 8 weeks, and see if there's any significant difference between the 2 groups after 12 weeks and 6 months. The study group size was also quite small, so seeing of these results can be replicated in a larger, more diverse group of participants would be helpful.

Why This Study Is Important for Managing Pain

Anxiety and pain can be persistent, often receding, only to flare up again and again. 

Therefore it's important to find an effective strategy to relieve the symptoms with the least negative impact on the body.

Anti-depressants are an effective way to manage anxiety, but at a cost. They often come with unpleasant side effects, and not everybody tolerates them well.

Some of the commonly reported side effects of escitalopram include:

• Headaches
• Feeling weak and tired
• Feeling sleepy
• Not being able to sleep
• Nausea
• Sweating a lot
• Dry mouth

Ironically some of these side effects are known to amplify and aggravate anxiety and pain - sleep is the big one here!

Being sleep deprived has all sorts of negative health implications - blood sugar management, mood, emotions, perception of pain, resilience to stress, decision making, appetite control, cognitive function etc.

These side effects can and will adversely your health and life long-term. It's not uncommon to be prescribed drugs to make you feel better because the drugs that are meant to make you feel better are making you feel worse!

Therefore if mindfulness meditation techniques are as effective, or at least not inferior to, taking powerful medications it would be beneficial to explore these.

You don't need to set aside 45 minutes every day to practice mindfulness meditation!

You can introduce the principles of being mindful very simply and in just a few minutes each day. Here are some examples:

• Take 10 deep, slow breaths before bed
• Practice heart centred breathing for 5 - 10 minutes
• Do a 10 - 15 minutes pandiculation practice
• Walking meditation

I use mindful movement, mindfulness techniques and guided meditations in The Befriend Your Body (BYB) Method to reduce anxiety, catastrophising and stress, This releases held muscle tension and reduces pain. These techniques often help to improve sleep too, with knock on positive benefits for pain and anxiety,

It's great news that this clinical trial has contributed to the body of evidence citing effective alternatives to strong drugs for managing symptoms. 

You should know that a commonly reported side effect of The BYB Method is increased awareness and compassion for your body - you have been warned!

Links to a summary article and an abstract of the original study are at the bottom of this post.

[NB} You should never suddenly stop your prescribed medication without consulting with your doctor first. It's always worth discussing benefits vs risks with any medication, as well as considering alternative treatments and lifestyle changes. 

NEXT STEPS

• Book into a Stretch, Yoga or Pilates class with me - these are a good introduction to The BYB Method
•  "The BYB Method: A roadmap to reducing pain and moving with ease" A 6 week small group course - learn more HERE
• Attend a mind-body retreat - these are deeply relaxing, fun, social small group experiences typically held in various locations within easy reach of Worthing, West Sussex. The next retreats are "Rest & Reflect" half-day winter retreat on Sunday 3rd December (FULL) and "Sun & Moon" mini retreat on Sunday 17th December (5x spaces). Click HERE to read more about them,
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

To find out more about my classes and retreats, or to join my email list you can contact me via any of these channels:

• Email at norma.pearson1@ntlworld.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.

Study Links

• https://www.cnbc.com/2022/11/09/mindfulness-meditation-reduces-anxiety-as-much-as-common-antidepressant-drug-study.html
• Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2023;80(1):13–21. doi:10.1001/jamapsychiatry.2022.3679 https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2798510?resultClick=1
• "Why Doesn't Pain Just Go Away?" Blog post