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

Lam, Raymond W.; McIntosh, Diane; Wang, JianLi; Enns, Murray W.; Kolivakis, Theo; Michalak, Erin E.; Sareen, Jitender; Song, Wei-Yi; Kennedy, Sidney H.; MacQueen, Glenda; Milev, Roumen; Parikh, Sagar V.; Ravindran, Arun

doi:10.1177/0706743716659416

Cited by 245 publications

(249 citation statements)

References 111 publications

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“…The full methods have been previously described, 3 but in summary, relevant studies in English and French published from January 1, 2009, to December 31, 2015, were identified using computerized searches of electronic databases (PubMed, PsychInfo, Cochrane Register of Clinical Trials), inspection of bibliographies, and review of other guidelines and major reports. Each recommendation includes the level of evidence for each graded line of treatment, using specified criteria ( Table 1).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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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

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Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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“…9 Across CAM treatments, exercise, St. John's wort, and LT (for seasonal depression) have the most robust evidence. For unipolar mild to moderate MDD, there is sufficient evidence and clinical support to recommend, as firstor second-line treatment, the use of exercise, LT, o-3 fatty acids and St. John's wort as monotherapies, and exercise, LT, yoga, o-3 fatty acids, and SAM-e as adjunctive treatments.…”

Section: Discussionmentioning

confidence: 99%

“…The full methods have been previously described, 9 but in summary, relevant English-language publications from January 1, 2009, to December 31, 2015, were identified using computerized searches of electronic databases (PubMed, PsychInfo, Cochrane Register of Clinical Trials), inspection of bibliographies, and review of other guidelines and major reports. Each recommendation is informed by the level of evidence for each graded line of treatment, using specified criteria ( Table 1).…”

Section: Methodsmentioning

confidence: 99%

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

Ravindran¹,

Balneaves²,

Faulkner³

et al. 2018

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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

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“…Briefly, evidence from meta-analyses can result in the highest level of evidence, but we did not rely on abstracts for conclusions. 2 We examined key factors of each study from any meta-analysis, including whether at least 2 studies used the same manual, choice of control conditions, replication by another research group, overall sample size, and finally the multiple subanalyses conducted. When there are multiple outcomes, divergent findings weaken conclusions.…”

Section: Dear Editormentioning

confidence: 99%

Rating Short-Term Psychodynamic Therapy for the Canadian Network for Mood and Anxiety Treatments Depression Guidelines

et al. 2017

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Dear Editor:We thank the authors of 2 letters inquiring how ratings were established with regards to short-term psychodynamic psychotherapy (STPP) for major depressive disorder in the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines.1 The second-line treatment recommendation for STPP captures the emerging nature of the evidence and clinical utility of STPP. Briefly, evidence from meta-analyses can result in the highest level of evidence, but we did not rely on abstracts for conclusions. 2 We examined key factors of each study from any meta-analysis, including whether at least 2 studies used the same manual, choice of control conditions, replication by another research group, overall sample size, and finally the multiple subanalyses conducted. When there are multiple outcomes, divergent findings weaken conclusions. Good scientists, and good clinicians, may reasonably disagree both on which subanalyses should have primacy, as well as the relative importance of study characteristics.Leichsenring and Steinert rightly mention that there are 2 studies of the de Jonghe et al.3 model of STPP-but one is a study designed to compare STPP alone to STPP with pharmacotherapy. 4 There was no control group for the psychotherapy, and in the results, the authors state, ''The advantage of combining antidepressants with STPP were equivocal. Neither the treating clinicians nor the independent observers were able to ascertain them.'' The second de Jonghe et al. model of STPP study, conducted by Driessen et al., 5 was a noninferiority trial comparing STPP to cognitive-behavioural therapy (CBT), and its authors conclude that noninferiority was demonstrated at posttreatment but could not be demonstrated for remission rates and follow-up measures. Both trials lend support but together fail to establish level 1 evidence for efficacy of that model of STPP. They subsequently cite the Connolly Gibbons et al.6 study, published after the review period of the CAN-MAT article, invoking the Luborsky 7 model of STPP. This, too, is a noninferiority trial without a control condition. As a single trial from a single research group, it does not satisfy the criterion of level 1 evidence. Furthermore, noninferiority was demonstrated on a primary outcome but not on 4 secondary outcomes, and both treatments had low remission rates.Town et al. cite various subanalyses from the Driessen et al. meta-analysis, but the issues of multiple divergent findings in that article and the use of many small and methodologically challenged studies do not allow for a clear, unequivocal conclusion as would be needed for a first-line treatment recommendation. Additionally, they state that other therapies may use different treatment manuals. While this is true, each of the other first-line treatments had evidence from at least 2 studies using the same specific type of therapy. Behavioural activation and mindfulness-based CBT each share many features with CBT, but each therapy has its own trials and evidence. Randomised controlled trials are needed in whic...

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

Cited by 245 publications

References 111 publications

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

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

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

Rating Short-Term Psychodynamic Therapy for the Canadian Network for Mood and Anxiety Treatments Depression Guidelines

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