Batelaan NM, et al. - This research entailed the appraisal of the risk of relapse and time to relapse after discontinuation of antidepressants, in patients with an anxiety disorder who responded to antidepressants. It also ascertained if the relapse risk was linked to the type of anxiety disorder, type of antidepressant, mode of discontinuation, duration of treatment and follow-up, comorbidity, and allowance of psychotherapy. Higher relapse rates among responders were found due to the discontinuation of antidepressant treatment, than with therapy continuation, up to one year of follow-up. The evidence paucity after a one year period, ought not to be understood as explicit advice to discontinue antidepressants after one year. The therapy was suggested to be directed by long term considerations, including relapse prevalence, side effects, and patients’ preferences, owing to the chronicity of anxiety disorders.

Methods

• The scheme of this paper was a systematic review and meta-analyses of relapse prevention trials.
• Data was extracted from the PubMed, Cochrane, Embase, and clinical trial registers (from inception to July 2016).
• Selected studies comprised of 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.
• 2 independent raters selected studies and extracted data.
• Random effect models measured the odds ratios for relapse, hazard ratios for time to relapse, and relapse prevalence per group.
• The impact of several categorical and continuous variables was gauges with subgroup analyses and meta-regression analyses respectively.
• The Cochrane tool inspected the bias.

Results

• 28 studies (n=5233) were included which analyzed the relapse with a maximum follow-up of one year.
• Low risk of bias was found.
• 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 did not exhibit any statistical significance.
• Time to relapse (n=3002) was shorter following the discontinuation of antidepressants (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.
• However, a marked variation was noted in the prevalence across studies, possibly due to differences in the length of follow-up.
• Higher dropout was reported in the placebo group (summary odds ratio 1.31, 1.06 to 1.63; n=27 studies).