Anxiety disorders often have a chronic course, and relapse and recurrence after remission is common. When combined with high prevalence rates and functional limitations, anxiety disorders score high on burden of disease rankings. It is therefore important that treatment does not merely focus on the initial (short-term) outcomes, but aims to optimise the long-term course. Like cognitive behavioral therapy, antidepressants are a first line treatment for anxiety disorders as they are effective and often well tolerated. Antidepressants are frequently used long-term; for example, in the U.S. approximately two-thirds of patients taking antidepressants take them for more than two years, and in Europe this is true for nearly half of relevant patients. This is, however, contrary to the advice of the international treatment guidelines, which recommend discussing discontinuation of antidepressants six to twenty-four months after remission of the anxiety disorder. Many anxiety patients do thus use antidepressants for a prolonged time after initial treatment. Problematic is that treatment guidelines are consensus-based and that there are no clear-cut long-term treatment recommendations for patients who achieved remission while using antidepressants. Relevant questions for clinical practice are, for example, whether antidepressants should be discontinued following remission or not, and if so when should they be discontinued and under which conditions.
The presentation serves to discuss evidence and potential pitfalls of long-term strategies, starting first with the question of whether long-term continuation of antidepressants should be considered a strategy to optimize the long-term prognosis of anxiety disorders based on meta-analytic results. Second, the views of patients with anxiety and/or depressive disorder(s) and their general practitioners on long-term antidepressant use, continuation and discontinuation, and discrepancies between them will be presented. Third, the results of a randomized controlled trial investigating the efficacy of a group cognitive behavioral therapy relapse prevention program for remitted anxiety disorder patients who discontinued antidepressant will be discussed along with clinical lessons learned from this trial.
**This content was captured at the 2019 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.
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- Scholten WD et a. The efficacy of a group CBT relapse prevention program for remitted anxiety disorder patients who discontinue antidepressant medication: a randomized controlled trial. Psychother Psychosom. 2018;87(4):240-242.
- Batelaan NM et al. 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. BMJ. 2017 Seo 13;358:j3927.
- Discuss with patients the potential pitfalls associated with long-term antidepressant use in clinical practice
- Interpret relapse rates after continuation and discontinuation of antidepressants and can discuss these with patients when initiating pharmacological treatment
- Identify motivations and barriers of patients and general practitioners to continue or discontinue antidepressants, and the discrepancies between them
- Discuss the effectiveness of group cognitive behavioral therapy with patients as a relapse prevention program in remitted anxiety patients who discontinued antidepressants
- Discuss evidence for response failure following reinstatement of a previously effective antidepressant
Estimated Time to Complete
Estimated Duration: 60 minutes
Begin Date: August 1, 2020
End Date: August 1, 2023
How to Earn Credit
Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned.
Continuing Education Credit
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this enduring CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
- Neeltje Batelaan M.D., Ph.D, Assistant Professor, Psychiatry, Amsterdam UMC. Reports no financial relationships with commercial interests.
- Renske Bosman, M.Sc, BSc, External PhD Candidate in Psychiatry, Amsterdam UMC and Research Associate, Amsterdam Public Health - Mental Health. Reports no financial relationships with commercial interests.
- Willemijn Scholten, M.D., Visiting Fellow, Psychiatry, Amsterdam UMC and Visiting Fellow, Amsterdam Public Health - Mental Health. Reports no financial relationships with commerical interests.
- Anton van Balkom, M.D., Ph.D., Psychiatrist and Professor of Psychiatry, Amsterdam UMC. Reports no financial relationships with commerical interests.
- Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.
- Katie Putnam, Membership Development Specialist, American Psychiatric Association. Reports no financial relationships with commercial interests.
- Ally Brown, Senior Program Manager, Online Learning, American Psychiatric Association. Reports no financial relationships with commercial interests.
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