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Beyond the Initial Successful Treatment of Anxiety Disorders with Antidepressants

Activity Type:

  • On Demand

Release Date: 8/15/2020

Expiration Date: 8/15/2023

  • AMA PRA Category 1: 1
  • Participation: 1



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.


  • General Member - Free
  • Resident-Fellow Member - Free
  • Medical Student Member - Free
  • Non-Member - $25.00

This course is free to APA members through the Course of the Month program. Promotional pricing valid August 15 - September 30, 2020.

Course References

  1. 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.
  2. 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.

Learning Objectives

  • 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


Target Audience

Psychiatrists, Residents/Fellows

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

Program Presenters

  • 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.

Program Planners

  • 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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Hardware/Software Requirements

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

  • Flash Player: Adobe Flash Player 10.3+ 
  • Browser: Firefox (latest version), Internet Explorer 8.0+, Safari 7.0+, Microsoft Edge (latest version) or Google Chrome (latest version)
  • Operating System: Windows XP+ or Mac OS X 10.4+ 
  • Internet Connection: 1 Mbps or higher

Minimum Requirements:

  • Windows PC: 500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Macromedia Flash Player 10.3 or higher; Sound Card at least 16-bit; audio playback with speakers for programs with video content
  • Macintosh:Mac OS X 10.4+ or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit; audio playback with speakers for programs with video content

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