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

Parikh, Sagar V.; Quilty, Lena C.; Ravitz, Paula; Rosenbluth, Michael; Pavlová, Barbara; Grigoriadis, Sophie; Velyvis, Vytas; Kennedy, Sidney H.; Lam, Raymond W.; MacQueen, Glenda; Milev, Roumen; Ravindran, Arun; Uher, Rudolf

doi:10.1177/0706743716659418

Cited by 371 publications

(226 citation statements)

References 164 publications

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“…92 The clinician should then reevaluate the diagnosis and consider treatment issues that may be affecting response. 93 Psychotherapy and neurostimulation approaches should also be considered for patients with an inadequate antidepressant response (see Section 2 94 and Section 4 95 respectively). Research on strategies for inadequate response to an initial antidepressant has been hampered by a lack of consensus on the concept and definition of treatment-resistant depression (TRD).…”

Section: How Do You Manage Inadequatementioning

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: How Do You Manage Inadequatementioning

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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“…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.…”

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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“…CBT has been shown to be equivalent to medication for mild and moderate anxiety and depression. Combining psychopharmacology with CBT may have a synergistic effect [6]. However, CBT requires time and resources, which partly explains its limited availability, even in public healthcare systems like Canada's.…”

Section: Key Pointsmentioning

confidence: 99%

The Internet and CBT: A New Clinical Application of an Effective Therapy

Gratzer¹,

Khalid-Khan²,

Balasingham³

2018

Cognitive Behavioral Therapy and Clinical Applications

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Mental disorders are disabling and common. Depression, for example, has greater global burden of disease than any physical disorder, and almost a third of people will experience some form of mental disorder in their lifetime. The effectiveness of psychological interventions is well established. Cognitive Behavioral Therapy is particularly effective for mood and anxiety disorders. But CBT is demanding of time and resources, partly explaining its limited availability, even in public systems. More and more people have access to the Internet and smartphones, even in the developing world. Internet therapies (including smart-phone apps) have been developed, offering CBT. Can technology help with access to CBT? In this chapter, we will look at the effectiveness of iCBT for several illnesses, based on new evidence from recent randomized controlled trials and meta-analyses, noting that while there is evidence for this therapy, not all programs have the same results. We consider iCBT in the real world, by looking at some popular apps and websites, including MoodGYM, and also present a case from The Scarborough Hospital (where we implemented a free-at-the-point-ofuse iCBT program), demonstrating how it can be applied in an outpatient setting. We also present the current strengths and limitations associated with iCBT. Finally, we consider future directions for this field, considering chatbots and the possibilities with Artificial Intelligence.

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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 371 publications

References 164 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

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

The Internet and CBT: A New Clinical Application of an Effective Therapy

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