Patient-Oriented Evidence That Matters

One-Third of Patients with Anxiety Disorder Will Relapse When Antidepressant Treatment Stops


Am Fam Physician. 2018 May 1;97(9):605.

Clinical Question

How common is relapse in patients with anxiety disorder following the discontinuation of treatment with an antidepressant?

Bottom Line

Discontinuing the antidepressant treatment in patients with anxiety disorders will cause a relapse in almost one-third of them. One in six patients previously treated successfully will also relapse despite continued treatment. (Level of Evidence = 1a–)


The authors searched three databases, including Cochrane Central, as well as clinical trial registries, to identify published and unpublished studies of patients with anxiety disorders (panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, or a specific phobia) who responded to antidepressant treatment and were subsequently randomized to continue antidepressant treatment or be switched to placebo. Two researchers independently selected research for inclusion, abstracted data, and evaluated study quality. The 28 included studies enrolled a total of 5,233 patients and followed them for eight to 52 weeks. Relapse occurred in 36.4% of patients who were switched to placebo, but also in 16.4% of patients who continued treatment (odds ratio = 3.11; 95% confidence interval, 2.48 to 3.89). There was no significant difference in relapse rates based on type of anxiety. The rate of relapse varied across the studies, likely because of the different durations of follow-up. All but two of the studies were sponsored by pharmaceutical companies, and six were previously unpublished; additional unpublished studies were identified, but data could not be obtained, increasing the risk of publication bias.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: 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 correction appears in BMJ. 2017;358:j4461]. BMJ. 2017;358:j3927.

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.



Want to use this article elsewhere? Get Permissions

More in AFP

Editor's Collections

Related Content

More in Pubmed


Sep 2021

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article