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

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

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

“…110 As comorbid medical burden and polypharmacy expand, the risk for pharmacokinetic and pharmacodynamic drug interactions increases (see Section 3). 58 In addition, rare antidepressant side effects in adults such as bone loss, serotonin syndrome, extrapyramidal side effects, and neuroleptic malignant syndrome are more common in the elderly. 111 Particular attention should be paid to falls, hyponatremia, and gastrointestinal bleeding, which are associated with SSRIs in general 112,113 and to QTc prolongation with citalopram.…”

Brexpiprazole in the Treatment of Major Depressive Disorder

“…5 Several strategies have been implemented following inadequate response to first-line ADT, including dose escalation, switching to another antidepressant, or augmenting with another medication. 6 Among these different approaches, the evidence is strongest for augmentation with atypical antipsychotics, specifically aripiprazole, quetiapine, and risperidone. [6][7][8] However, early discontinuation of treatment due to adverse effects and to concern about longterm safety have restricted their use.…”

Utilizing the <em>DSM-5</em> Anxious Distress Specifier to Develop Treatment Strategies for Patients With Major Depressive Disorder

“…The 2016 CANMAT guidelines 36 recommend choosing an antidepressant with efficacy in generalized anxiety disorder for patients with anxious distress, but this recommendation is level 4 (expert opinion) evidence; the 2012 guidelines specific to MDD with comorbid anxiety 37 found no strong basis for altering pharmacotherapeutic treatment in the presence of anxiety. The 2009 APA guidelines 25 predate the anxious distress specifier.…”