Can meditation replace medication for anxiety? Here’s what the science says

It is widely believed that meditation is good for you, and science supports this, at least in part. In recent years, there has been much talk of meditation as a way of reducing stress and anxiety, to the extent that some are wondering whether it might even replace medication. The answer is not straightforward: it depends on the type of condition, its severity and many other individual factors. But there is one important thing we do know, and it is worth stating clearly, especially as we approach International Yoga Day on 21 June.

Anxiety disorders are among the most common mental health problems in the world: in 2021, 359 million people were affected, representing 4.4 per cent of the world’s population. Although effective treatments exist, the World Health Organisation estimates that only around one in four people with an anxiety disorder receives adequate treatment. In Italia, as documented by the Consensus Conference organised under the auspices of the Istituto Superiore di Sanità, psychological treatments for anxiety are often underused, and many patients are not identified or do not receive appropriate care. Not all anxiety disorders are the same: they include generalised anxiety disorder, panic disorder, social phobia and agoraphobia, amongst others. For all of these, the treatments recommended by the main international guidelines include psychotherapy – in particular cognitive-behavioural therapy – and, in some cases, specific medication.

The meditation techniques that have been most extensively studied in a clinical setting form part of the MBSR (Mindfulness-Based Stress Reduction) programme, which was developed in the 1970s in the United States. This is a structured programme lasting around 8 weeks, comprising group sessions and daily individual practice – the same approach we discussed in the factsheet “Does meditation reduce migraine pain?”, where MBSR also showed promising results in the management of chronic pain. A systematic review and meta-analysis published in JAMA Internal Medicine analysed the results of 47 randomised controlled trials, concluding that mindfulness-based meditation programmes have a moderate effect on reducing anxiety symptoms. The effect is real, but it is not large: on a standardised scale, the difference compared with doing nothing amounts to a partial improvement, not a cure.

A more recent study, published in JAMA Psychiatry in 2023, directly compared MBSR with a drug commonly used to treat anxiety disorders in 276 adults diagnosed with generalised anxiety disorder, panic disorder or social phobia. After eight weeks, the improvements in the two groups were statistically equivalent. The side effects, however, were very different: nearly 79 per cent of participants treated with the medication reported side effects such as nausea, headaches or fatigue, compared with 15 per cent of the group that practised meditation. This is an interesting finding, but it should be interpreted with caution: this is a single study, conducted on a selected sample and in a controlled setting, far removed from everyday clinical practice.

No, that is not what the research suggests. The findings just mentioned do not mean that meditation works for everyone, nor that it can replace treatment prescribed by a doctor in every case. Firstly, the most promising studies concern moderate forms of anxiety: for more severe disorders, the evidence in favour of meditation alone is still insufficient. Secondly, meditation requires a considerable commitment: in the MBSR programme, participants attend two-and-a-half-hour sessions once a week, plus 45 minutes of independent practice every day. Not everyone manages to maintain this discipline, and its effectiveness depends heavily on the amount of time actually devoted to the practice.