Discontinuation of Antidepressants Shortens Time to Relapse

Patients with anxiety disorders who discontinued antidepressant use after treatment response experienced higher rates of relapse and shorter time to relapse, according to the findings of a recent study.

In their systematic review, the researchers searched PubMed, Cochran, Embase and clinical trial registries for studies that included patients with anxiety disorders that responded to antidepressants, randomly assigned patients to continue receiving therapy or switch to placebo, or compared relapse rates and time to relapse.
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The researchers used random effects models to estimate odds ratios (OR) for relapse, calculate hazard ratios for time to relapse, and determine the relapse prevalence per group. In addition, they explored the effects of various categorical and continuous variables in subgroup analyses. 

Twenty-eight studies including data from 5233 patients were assessed in the meta-analysis. The researchers found that the odds of relapse increased with discontinuation compared with continuing antidepressant treatment (OR 3.11), however, subgroup and meta-regression analyses showed no statistical significance.

Additionally, the 3002 patients in the placebo group experienced shorter time to relapse after discontinuing antidepressants, and had a higher study dropout rate.

The relapse prevalence for the placebo group was 36.5% compared with 16.4% for the antidepressant group. However, prevalence varied across studies, which was mostly likely due to differences in the length of follow-up.

“Up to one year of follow-up, discontinuation of antidepressant treatment results in higher relapse rates among responders compared with treatment continuation,” the researchers concluded. “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.”

—Melissa Weiss

Reference:

Batelaan NM, Bosman RS, Muntingh A, Scholten WD, Huijbregts, 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. https://doi.org/10.1136/bmj.j3927.