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Can J Psychiatry. 2016 Sep;61(9):576-87. doi: 10.1177/0706743716660290. 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 5. Complementary and Alternative Medicine Treatments.

Author information

1
Department of Psychiatry, University of Toronto, Toronto, Ontario arun.ravindran@camh.ca.
2
Department of Psychiatry, University of Toronto, Toronto, Ontario.
3
School of Kinesiology, University of British Columbia, Vancouver, British Columbia.
4
Department of Psychiatry, University of Ottawa, Ottawa, Ontario.
5
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
6
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia.
7
Department of Psychiatry, University of Calgary, Calgary, Alberta.
8
Department of Psychiatry, Queen's University, Kingston, Ontario.
9
Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.

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. "Complementary and Alternative Medicine Treatments" is the fifth of six sections of the 2016 guidelines.

RESULTS:

Evidence-informed responses were developed for 12 questions for 2 broad categories of complementary and alternative medicine (CAM) interventions: 1) physical and meditative treatments (light therapy, sleep deprivation, exercise, yoga, and acupuncture) and 2) natural health products (St. John's wort, omega-3 fatty acids; S-adenosyl-L-methionine [SAM-e], dehydroepiandrosterone, folate, Crocus sativus, and others). Recommendations were based on available data on efficacy, tolerability, and safety.

CONCLUSIONS:

For MDD of mild to moderate severity, exercise, light therapy, St. John's wort, omega-3 fatty acids, SAM-e, and yoga are recommended as first- or second-line treatments. Adjunctive exercise and adjunctive St. John's wort are second-line recommendations for moderate to severe MDD. Other physical treatments and natural health products have less evidence but may be considered as third-line treatments. CAM treatments are generally well tolerated. Caveats include methodological limitations of studies and paucity of data on long-term outcomes and drug interactions.

KEYWORDS:

clinical practice guidelines; complementary and alternative medicine; evidence-based medicine; exercise; light therapy; major depressive disorder; meta-analysis; natural health products; sleep deprivation; systematic reviews

PMID:
27486153
PMCID:
PMC4994794
[Available on 2017-03-01]
DOI:
10.1177/0706743716660290
[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: AVR has received speaker and consultant honoraria or 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. LB, GF, AO, RLM, and LR have no disclosures. DM has received honoraria for ad hoc speaking or received advising/consulting or research funds from Allergan, Bristol-Myers Squibb, Lundbeck, Janssen-Ortho, Otsuka, Pfizer, Shire, and Sunovion. LNY has received honoraria for ad hoc speaking or received advising/consulting or research funds from AstraZeneca, Bristol-Myers Squibb, Canadian Institutes of Health Research, Canadian Psychiatric Foundation, Eli Lilly, Forest, GlaxoSmithKline, Johnson & Johnson, National Alliance for Research on Schizophrenia and Depression, Novartis, Pfizer, Abbott, Servier, Stanley Foundation, and Wyeth. SHK has received honoraria for ad hoc speaking or received advising/consulting or research funds from Allergan, Brain Canada, Bristol-Myers Squibb, Canadian Institutes of Health Research, Janssen, Lundbeck, Ontario Brain Institute, Pfizer, St. Jude Medical, Servier, and Sunovion. 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. GMM has been on advisory board or speaker for Janssen, Lilly, Lundbeck, and Pfizer. RVM has received speaker and consultant honoraria or 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. SVP has been a consultant to Bristol Myers Squibb, Lundbeck, and Takeda; has had a research contract with Assurex; and has equity in Mensante.

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