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
- PMID: 28903922
- PMCID: PMC5596392
- DOI: 10.1136/bmj.j3927
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
Erratum in
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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 Sep 25;358:j4461. doi: 10.1136/bmj.j4461. BMJ. 2017. PMID: 28947609 Free PMC article. No abstract available.
Abstract
Objectives To examine the risk of relapse and time to relapse after discontinuation of antidepressants in patients with anxiety disorder who responded to antidepressants, and to explore whether relapse risk is related to type of anxiety disorder, type of antidepressant, mode of discontinuation, duration of treatment and follow-up, comorbidity, and allowance of psychotherapy.Design Systematic review and meta-analyses of relapse prevention trials.Data sources PubMed, Cochrane, Embase, and clinical trial registers (from inception to July 2016).Study selection Eligible studies included patients with anxiety disorder who responded to antidepressants, randomised patients double blind to either continuing antidepressants or switching to placebo, and compared relapse rates or time to relapse.Data extraction Two independent raters selected studies and extracted data. Random effect models were used to estimate odds ratios for relapse, hazard ratios for time to relapse, and relapse prevalence per group. The effect of various categorical and continuous variables was explored with subgroup analyses and meta-regression analyses respectively. Bias was assessed using the Cochrane tool.Results The meta-analysis included 28 studies (n=5233) examining relapse with a maximum follow-up of one year. Across studies, risk of bias was considered low. Discontinuation increased the odds of relapse compared with continuing antidepressants (summary odds ratio 3.11, 95% confidence interval 2.48 to 3.89). Subgroup analyses and meta-regression analyses showed no statistical significance. Time to relapse (n=3002) was shorter when antidepressants were discontinued (summary hazard ratio 3.63, 2.58 to 5.10; n=11 studies). Summary relapse prevalences were 36.4% (30.8% to 42.1%; n=28 studies) for the placebo group and 16.4% (12.6% to 20.1%; n=28 studies) for the antidepressant group, but prevalence varied considerably across studies, most likely owing to differences in the length of follow-up. Dropout was higher in the placebo group (summary odds ratio 1.31, 1.06 to 1.63; n=27 studies).Conclusions Up to one year of follow-up, discontinuation of antidepressant treatment results in higher relapse rates among responders compared with treatment continuation. The lack of evidence after a one year period should not be interpreted as explicit advice to discontinue antidepressants after one year. Given the chronicity of anxiety disorders, treatment should be directed by long term considerations, including relapse prevalence, side effects, and patients' preferences.
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Conflict of interest statement
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
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Comment in
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PURL: Antidepressant Tx for anxiety disorders: How long?J Fam Pract. 2019 Sep;68(7):409-410. J Fam Pract. 2019. PMID: 31532817 Free PMC article.
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References
-
- Batelaan NM, Rhebergen D, Spinhoven P, van Balkom AJ, Penninx BW. Two-year course trajectories of anxiety disorders: do DSM classifications matter?J Clin Psychiatry 2014;75:985-93. 10.4088/JCP.13m08837 pmid:24912140. - DOI - PubMed
-
- Spinhoven P, Batelaan N, Rhebergen D, van Balkom A, Schoevers R, Penninx BW. Prediction of 6-yr symptom course trajectories of anxiety disorders by diagnostic, clinical and psychological variables. J Anxiety Disord 2016;44:92-101. 10.1016/j.janxdis.2016.10.011 pmid:27842240. - DOI - PubMed
-
- Rhebergen D, Batelaan NM, de Graaf R, et al. The 7-year course of depression and anxiety in the general population. Acta Psychiatr Scand 2011;123:297-306. 10.1111/j.1600-0447.2011.01677.x pmid:21294714. - DOI - PubMed
-
- Bruce SE, Yonkers KA, Otto MW, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 2005;162:1179-87. 10.1176/appi.ajp.162.6.1179 pmid:15930067. - DOI - PMC - PubMed
-
- Scholten WD, Batelaan NM, van Balkom AJLM, Wjh Penninx B, Smit JH, van Oppen P. Recurrence of anxiety disorders and its predictors. J Affect Disord 2013;147:180-5. 10.1016/j.jad.2012.10.031 pmid:23218248. - DOI - PubMed
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