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–)

Synopsis

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searched three databases, including Cochrane Central, as well as clinical trial registries, to identify published and unpublished studies of patients with anxiety disorders (panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder,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 All but two of the studies were sponsored by pharmaceutical companies, and six were previously unpublished; additional unpublished studies were identified, but data could not be obtained, increasing the risk of publication bias.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:BatelaanNMBosmanRCMuntinghAScholtenWDHuijbregtsKMvan BalkomAJLMRisk 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]. BMJ2017;358:j3927.