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Can J Psychiatry. 2016 Sep;61(9):540-60. doi: 10.1177/0706743716659417. Epub 2016 Aug 2.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments.

Author information

1
Department of Psychiatry, University of Toronto, Toronto, Ontario *Co-first authors. sidney.kennedy@uhn.ca.
2
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia *Co-first authors.
3
Department of Psychiatry, University of Toronto, Toronto, Ontario.
4
Department of Psychiatry, L'Université de Montréal, Montréal, Quebec.
5
Department of Psychiatry, McGill University, Montréal, Quebec.
6
Department of Psychiatry, University of Ottawa, Ottawa, Ontario.
7
Department of Psychiatry, Memorial University, St. John's, Newfoundland.
8
Department of Psychiatry, University of Calgary, Calgary, Alberta.
9
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
10
Department of Psychiatry, Queen's University, Kingston, Ontario.
11
Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
12
Canadian Pharmacists Association, Ottawa, Ontario.
13
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia.

Erratum in

Abstract

BACKGROUND:

The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals.

METHODS:

Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Pharmacological Treatments" is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants.

RESULTS:

Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and frequent monitoring, and assessing clinical and functional outcomes with measurement-based care; 2) comparative aspects of antidepressant medications based on efficacy, tolerability, and safety, including summaries of newly approved drugs since 2009; 3) practical approaches to pharmacological management, including drug-drug interactions and maintenance recommendations; and 4) managing inadequate response and treatment resistance, with a focus on switching antidepressants, applying adjunctive treatments, and new and emerging agents.

CONCLUSIONS:

Evidence-based pharmacological treatments are available for first-line treatment of MDD and for management of inadequate response. However, given the limitations of the evidence base, pharmacological management of MDD still depends on tailoring treatments to the patient.

KEYWORDS:

antidepressants; antipsychotics; clinical practice guidelines; clinical trials; evidence-based medicine; major depressive disorder; meta-analysis; pharmacotherapy; randomized controlled trial

PMID:
27486148
PMCID:
PMC4994790
[Available on 2017-03-01]
DOI:
10.1177/0706743716659417
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SHK has received honoraria for ad hoc speaking or advising/consulting or received research funds from Allergan, Brain Canada, Bristol Myers Squibb, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Johnson & Johnson, Lundbeck, Lundbeck Institute, Medscape, Ontario Brain Institute, Pfizer, Servier, St. Jude Medical, Sunovion, and Takeda. RWL has received honoraria for ad hoc speaking or advising/consulting or received research funds from Asia-Pacific Economic Cooperation, AstraZeneca, Brain Canada, Bristol Myers Squibb, Canadian Institutes of Health Research, Canadian Depression Research and Intervention Network, Canadian Network for Mood and Anxiety Treatments, Canadian Psychiatric Association, Coast Capital Savings, Johnson & Johnson, Lundbeck, Lundbeck Institute, Medscape, Pfizer, St. Jude Medical, Takeda, University Health Network Foundation, and Vancouver Coastal Health Research Institute. RSM has received research grants and/or personal fees and/or nonfinancial support from AstraZeneca, Bristol Myers Squibb, CME Outfitters, Eli Lilly, France Foundation, GlaxoSmithKline, I3CME, Janssen-Ortho, Lundbeck, Merck, National Alliance for Research on Schizophrenia and Depression, National Institutes of Mental Health, Optum Health, Organon, Pfizer, Physicians’ Postgraduate Press, Shire, and Stanley Medical Research Institute, SVT has received honoraria for ad hoc speaking or advising/consulting or received research funds from Bristol-Myers Squibb, Eli Lilly, Janssen, Lundbeck, Otsuka, Pfizer, Purdue, Shire, Sunovion, and Valeant. VB has no disclosures. PB has received research grants, personal fees, and/or nonfinancial support from AstraZeneca, Bristol Myers Squibb, Eli Lilly, Forest, Euthymics, Janssen, Lundbeck, Merck, Otsuka, Pfizer, Pierre Fabre, Servier, Shire, Takeda, and Valeant. MH has no disclosures. FJ has no disclosures. AJL has received research grants, personal fees, and/or nonfinancial support from Eli Lilly, Janssen, Lundbeck, and Sanofi-Aventis, GMM has received honoraria for ad hoc speaking or advisory/consulting from Janssen, Lilly, Lundbeck, and Pfizer. SJM has received fellowship funding from Pfizer. DM has received honoraria for ad hoc speaking or advising/consulting or received research funds from Allergan, Bristol Myers Squibb, Lundbeck, Janssen-Ortho, Otsuka, Pfizer, Shire, and Sunovion. RVM has received honoraria for ad hoc speaking or advising/consulting or received research funds from Allergan, Bristol Myers Squibb, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Canadian Psychiatric Association, Eli Lilly, Johnson & Johnson, Lallemand, Lundbeck, Merck, Ontario Brain Institute, Ontario Mental Health Foundation, Otsuka, Paladin, Pfizer, Queen’s University, Sunovion, Takeda, the University Health Network Foundation, and Valeant. DJM has received research funds from Canadian Institutes of Health Research, Canadian Foundations for Innovation, National Alliance for Research in Schizophrenia and Depression, Ontario Mental Health Foundation, National Institutes of Health, and the University of Toronto. SVP has been a consultant to Bristol Myers Squibb, Lundbeck, and Takeda; has had a research contract with Assurex; and has equity in Mensante. NLP has no disclosures. AVR has received honoraria for ad hoc speaking or advising/consulting or received research funds from Bristol Myers Squibb, Canadian Depression Research and Intervention Network, Canadian Foundation for Innovation and the Ministry of Economic Development and Innovation, Canadian Institutes of Health Research, Grand Challenges Canada, Janssen, Lundbeck, Ontario Mental Health Foundation, Pfizer, and Sunovion. RU has received research funds from European Commission Framework 6.

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