Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy.
BACKGROUND
In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field.


METHODS
The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included Levels of Evidence and expert clinical support. This section on "Pharmacotherapy" is one of 5 guideline articles.


RESULTS
Despite emerging data on efficacy and tolerability differences amongst newer antidepressants, variability in patient response precludes identification of specific first choice medications for all patients. All second-generation antidepressants have Level 1 evidence to support efficacy and tolerability and most are considered first-line treatments for MDD. First-generation tricyclic and monoamine oxidase inhibitor antidepressants are not the focus of these guidelines but generally are considered second- or third-line treatments. For inadequate or incomplete response, there is Level 1 evidence for switching strategies and for add-on strategies including lithium and atypical antipsychotics.


CONCLUSIONS
Most of the evidence is based on trials for registration and may not reflect real-world effectiveness.


CONCLUSIONS
Second-generation antidepressants are safe, effective and well tolerated treatments for MDD in adults. Evidence-based switching and add-on strategies can be used to optimize response in MDD that is inadequately responsive to monotherapy.
Lam
Raymond W
RW
University of British Columbia, Canada. r.lam@ubc.ca
Kennedy
Sidney H
SH
Grigoriadis
Sophie
S
McIntyre
Roger S
RS
Milev
Roumen
R
Ramasubbu
Rajamannar
R
Parikh
Sagar V
SV
Patten
Scott B
SB
Ravindran
Arun V
AV
D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004347:Drug Interactions; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors