When Shrinks Put Mindfulness On The Couch

By Alexandra Morris
CommonHealth intern

Can medications and meditation co-exist?

Or, put another way, does mindfulness — the deliberate act of paying attention to the present moment and observing your thoughts drift by — have a place in psychiatric care?

The answer, according to some doctors: yes, maybe, at least for some patients.

At a conference held earlier this month at the University of Massachusetts Medical School, psychiatrists David Lovas of Dalhousie University and Zev Schuman-Olivier of Harvard Medical School and the Cambridge Health Alliance made the case for and against mindfulness and psychiatric drugs in treating patients with depression, anxiety, schizophrenia, bipolar disorder, and other mental illnesses.

Over the past twenty years or so, the number of patients taking antidepressants and antipsychotics has increased substantially. And in many cases, patients are on multiple drugs at once: one third of psychiatric outpatients are on three or more drugs, according to one study.

(Synergy by Jasmine/flickr)

(Synergy by Jasmine/flickr)

So researchers have begun to examine whether mindfulness, which can include walking meditation, body scan meditation (to bring awareness to each part of the body in turn), mindful eating or yoga, or mindful listening can significantly reduce some of the anxiety and distress associated with such illnesses.

“We’re witnessing a culture that is focused and organized in some ways around medication as a primary form of treatment,” said Schuman-Olivier. “On the other hand, people can overstate the power of mindfulness intervention.”

It’s a careful balancing act, they say: for some, mindfulness-based therapy may be more effective at relieving stress and addressing mental health symptoms, while others may benefit more from medications or a combination of medication and meditation.

In some cases, mindfulness can produce negative side effects – it has been shown to draw out negative memories of past events.

Still, mindfulness meditation is being adopted more and more as a practice to improve health and mental well-being. The U.S. Marines, for example, are using these meditation practices to improve their attention and working memory, according to a recent New York Times report.

Earlier this year, JAMA Internal Medicine published a paper that looked at how mindfulness meditation programs affect stress and well-being. The study, widely covered by the news media, reviewed 47 studies and found that the meditation programs helped improve levels of anxiety, depression, and pain, although it did not have an effect on sleep, weight, or substance abuse.

In the discussion, the researchers compared the effect of meditation to the effect of antidepressant treatment. But what they failed to discuss, said Lovas, was the fact that in a good proportion of the studies analyzed, a number of patients were still taking medications.

From the study:

“During the course of 2 to 6 months, the mindfulness meditation program effect size estimates ranged from 0.22 to 0.38 for anxiety symptoms and 0.23 to 0.30 for depressive symptoms. These small effects are comparable with what would be expected from the use of an antidepressant in a primary care population but without the associated toxicities.”

“We’re not saying this is comparable in terms of a head to head trial,” said Dr. Madhav Goyal of Johns Hopkins University’s Department of Medicine and lead author of the JAMA paper. “It’s not a statement that’s saying you can replace antidepressants with this. What it’s saying is that we’re finding an effect of these programs and the effect is something that is at least as big as what you would see with an antidepressant in other studies, and that’s something to pay attention to.”

Nevertheless, some media outlets framed the study as a direct comparison: mindfulness vs. drug treatment. In Forbes, for example, the headline read: For Depression Treatment, Meditation Might Rival Medication. And in the Boston Globe: Can Meditation Top Medication?

“We have to be humble and cautious when we’re discussing mindfulness interventions with people in terms of how beneficial it might be,” said Lovas. “We don’t know for sure in all cases if this this means you can come off medications completely and just use mindfulness.”

It shouldn’t be a question of one or the other, said the psychiatrists. “Mindfulness is not a panacea nor are medications,” said Lovas. Each patient is different. What works for one person may not make sense for another.

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