Can Meditation Treat Anxiety and Depression Better Than Medication?

Researchers have been testing whether mindfulness meditation can ease anxiety and depression, and the early picture is promising. Writing for Forbes, Alice Walton points to a body of work suggesting that a regular meditation practice lowers symptoms, enough that it might stand on its own as a way to address anxiety without reaching for a prescription. She reads the recent evidence as support for that idea rather than wishful thinking.

Her case leans heavily on a review published in JAMA Internal Medicine. The authors sifted through thousands of prior studies and kept only a small set of randomized clinical trials, the kind of design scientists trust most. Their conclusion, as Walton quotes it, is modest but striking: meditation is no cure-all, yet for depression, anxiety, and pain it can hold its own against medication. That raises a fair question about whether it could work as a standalone treatment and not only as an add-on.

One of the studies she cites came out of Johns Hopkins, led by Madhav Goyal, MD, MPH. His team started from more than 18,000 earlier papers and narrowed to 47 randomized trials covering over 3,500 people who were assigned to practice mindfulness meditation or other relaxation methods. The effect size meditation showed for depression landed at 0.3. On its face that sounds small. Walton argues it is actually a good sign, because the typical drug used for anxiety and depression also comes in around 0.3. If the two produce comparable results, meditation has an obvious edge: it skips the side effects that come with pills.

She also makes the point that depression is hard to treat at all, with success rates that tend to run low. Measured against that backdrop, a 0.3 effect for meditation looks better than the number alone suggests.

Goyal himself sounded optimistic. Most of the trials in the review used brief training windows, often eight weeks or less, which is short compared to how long people usually spend building other skills. Even so, participants showed a small but steady improvement in anxiety, depression, and pain. He wondered aloud whether longer practice and more skill might push the benefits higher. That possibility is part of what makes the findings interesting: more training could, in theory, close or even reverse the gap with medication.

There are plausible reasons the brain responds this way. Walton notes that mindfulness seems to sharpen attention regulation, body awareness, and emotional control, and it shifts how people relate to their own thoughts, a process sometimes called decentering, all of which matter in depression. On the biological side, MRI research links meditation to quieter activity in the amygdala, which runs the stress response, and to reduced activity in the default mode network, the circuitry that lights up when the mind drifts from one thought to the next, a pattern often tied to unhappiness and stress.

The scale of the need is hard to ignore. A 2012 report from the National Alliance on Mental Illness found that roughly 6.7 percent of American adults, about 14.8 million people, live with major depression. Anxiety disorders reach further still, affecting about 18.1 percent, or 42 million people, including panic disorder, OCD, PTSD, generalized anxiety, and various phobias.

As those numbers climb, it makes sense to have more than one tool for managing symptoms. Mindfulness meditation can run alongside medication or replace it. A lot of people are wary of drugs and go untreated as a result, and an approach with no side effects could reach some of them. What I would like to see next is a study that pins down how a set number of training sessions changes outcomes for depression and anxiety.

It also seems worth training doctors, psychiatrists, and psychotherapists in these methods so they can hand them to patients directly. That would take serious programs, since mindfulness is not part of standard medical school coursework. My hope is that it becomes one more option for the people working with anyone trying to manage depression and anxiety. (Kim Nygaard, M.S.)

A personal note: I genuinely think meditation can treat anxiety and depression at least as well as medication, maybe better. Close to a fifth of Americans carry a diagnosis of depression, an anxiety disorder, or both, and the true figure is almost certainly higher once you count the people who were never diagnosed, were diagnosed wrong, or turned down treatment. Meditation gives me a way to reach my own feelings and deflect outside triggers instead of just burying them. More often than not, the biggest triggers turn out to be family and close friends. The people we love and see the most are frequently the ones, or the source of the situations, that stir up the deepest stress and the greatest toll on our health. Meditation takes many shapes depending on the person: prayer, plain solitude, quiet time, a yoga class can all be contemplative and count. Each of us has to figure out which form works, and the push should simply be to keep trying until something sticks. (Bergen)

Source: Walton, Alice. For Depression Treatment, Meditation Might Rival Medication. Forbes, January 7, 2014.