Discontinuation of antidepressants before 1 year may increase relapse risk in patients with anxiety
Discontinuation of antidepressants resulted in higher relapse rates after a 1-year follow-up period compared with patients who continued the treatment.
Discontinuation of antidepressants in patients with anxiety disorder who responded to the treatment resulted in higher relapse rates compared with patients who continued the treatment for up to 1 year, according to data published in the BMJ.
Neeltje Batelaan, MD, PhD, Department of Psychiatry and Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, the Netherlands, and colleagues conducted a systematic review and meta-analyses including 28 studies examining relapse with a maximum 1-year follow-up period.
The results showed that antidepressant discontinuation increased the odds of relapse compared with continuing therapy (summary odds ratio, 3.11). Additionally, the time to relapse was shorter when antidepressants were discontinued (summary hazard ratio, 3.63). The relapse rate was 36.4% in patients who switched to placebo and 16.4% in patients receiving long-term use of antidepressants, but prevalence varied across studies due to varying lengths of follow-up.
Several exploratory subgroup analyses were also conducted, which included type of anxiety disorder, type of antidepressant, mode of discontinuation, allowing concurrent psychotherapy, and exclusion of comorbidities. However, the analyses did not affect the odds ratio of relapse.
The researchers note that for a treatment duration up to 1 year, these results suggest that antidepressants outperform placebo in preventing relapse and are well-tolerated over time.
“When considering antidepressants in acute phase treatment, the relapse risk in the case of later discontinuation needs to be discussed and evaluated from the start of the treatment,” the authors concluded. “On the basis of the evidence presented here, the advice is to continue antidepressants for at least a year.”
Batelaan NM, Bosman RC, Muntingh A, Scholten WD, 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 [published online September 13, 2017]. BMJ. doi:10.1136/bmj.j3927