title: Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy.
abstract: 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.
authors.affiliation: University of British Columbia, Canada. r.lam@ubc.ca
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.forename: Sophie
authors.initials: S
authors.lastname: Grigoriadis
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.forename: Roumen
authors.initials: R
authors.lastname: Milev
authors.forename: Rajamannar
authors.initials: R
authors.lastname: Ramasubbu
authors.forename: Sagar V
authors.initials: SV
authors.lastname: Parikh
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.forename: Arun V
authors.initials: AV
authors.lastname: Ravindran
mesh_terms: 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
chemical_list: D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors