Risk of Anxiety Disorder Relapse After Discontinuing Antidepressants

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Researchers cautioned that this meta-analysis should not be interpreted as advice to discontinue antidepressants after 1 year.
Researchers cautioned that this meta-analysis should not be interpreted as advice to discontinue antidepressants after 1 year.

Results from a meta-analysis published in the British Medical Journal (BMJ) showed that patients with anxiety disorder who responded to antidepressants had lower relapse rates and longer time to relapse when they continued depression treatment at up to 1 year of follow-up.

To examine whether the risk of relapse or time to relapse in this population was related to type of anxiety disorder, duration of previous treatment, duration of follow-up, mode of discontinuation, or concurrence or absence of psychotherapy, researchers conducted a systematic review and meta-analysis of relapse prevention trials from inception to July 2016 using 28 studies (n=5233) from PubMed, Cochrane, Embase, and clinical trial registers.

The researchers selected trials that focused on patients with a variety of anxiety disorders, including panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and specific phobias. Patients with comorbidities were also included in the trial. Altogether there were 2625 patients in the antidepressant group and 2608 in the placebo group.

The patients selected for the study had all responded to antidepressants and were then randomly assigned in a double-blind fashion to either continue the antidepressant or switch to a placebo.

Relapse rates and time to relapse were compared in the two groups. At up to 1 year of follow-up, patients who discontinued antidepressant treatment had higher relapse rates compared with patients who continued their medications (summary odds ratio [OR] 3.11, 95% CI, 2.48-3.89). When patients discontinued antidepressants, time to relapse (n=3002) was shorter (summary hazard ratio 3.63, 2.58-5.10; n=11 studies). Summary relapse rates were 36.4% in the placebo group (30.8% to 42.1%; n=28 studies) and were 16.4% in the antidepressant group (12.6% to 20.1%; n=28 studies). However, these rates varied highly across studies, most likely owing to differences in follow-up length. Dropout was higher in the placebo group (summary OR 1.31, 1.06-1.63; n=27 studies).

Results from this meta-analysis found that relapse rate and time to relapse was not significantly affected by type of anxiety disorder, duration of previous treatment, duration of follow-up, mode of discontinuation, or concurrence or absence of psychotherapy.

The researchers cautioned that this meta-analysis should not be interpreted as advice to discontinue antidepressants after 1 year. Whether or not to continue antidepressant treatment should be decided according to long-term considerations of relapse prevalence — given the chronicity of anxiety disorders — any side effects and their severity, and patient preference. Each patient and their doctor should discuss what is best in their individual case for the long term.

Reference

Batelaan N, Bosman RC, Muntingh A, Scholten WE, Huijbregts KM, van Balkom AJLM. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ. 2017;358:j3927.

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