Remission / Continuation Phase Treatment

Wonderful — Your patient is in remission.

Here are some recommendations regarding Continuation Phase Treatment:

• Most anxiety guidelines recommend continuing the antidepressant treatment for at least one year following remission
• Patients with a first episode of an anxiety disorder who enter remission should be followed every 3 months for the first year and at the end of 12 months should be evaluated for slow tapering and discontinuation of antidepressant medication (see antidepressant table and go to STOP column for guidance as to how to do this)
• Given the lack of evidence for how long to continue antidepressant medications in anxiety it is reasonable to consider the guidelines for the treatment of depression in more complex situations
• CANMAT guidelines for depression recommend that for those with risk factors for recurrence antidepressants should be continued 2  years or longer
• Risk factors for recurrence include:
  • frequent, recurrent episodes
  • severe episodes (psychosis, severe impairment, suicidality)
  • chronic episodes
  • presence of comorbidity (psychiatric or other medical conditions)
  • presence of residual symptoms
  • difficult-to-treat episodes
• For patients who were augmented with antipsychotics, consider gradually tapering and discontinuing the antipsychotics after 6-9 months.