The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid metabolic disorders.
BACKGROUND
One goal of the Canadian Network for Mood and Anxiety Treatments (CANMAT) is to develop evidence-based and best practice educational programs and recommendations. Our group conducted a comprehensive literature review to provide evidence-based recommendations for treating metabolic comorbidity in individuals with major depressive disorder (MDD) and bipolar disorder (BD).


METHODS
We searched PubMed for all English-language articles published January 1966 to November 2010 using BD and MDD cross-referenced with metabolic syndrome, obesity, diabetes mellitus, hypertension, and dyslipidemia. That search was augmented by a review of articles reporting outcomes of an intervention targeting components of metabolic syndrome in individuals with MDD or BD.


RESULTS
Consensus exists for the recommendation that individuals with MDD and BD should be routinely screened for risk factors that increase risk for metabolic syndrome. For excess weight, the best-studied pharmacologic approaches are metformin and topiramate, with emerging evidence for liraglutide and modafinil. For binge eating disorder, the best evidence in mood disorders was for cognitive-behavioral therapy as well as topiramate, zonisamide, and in select cases selective serotonin reuptake inhibitors. For dysglycemia, dyslipidemia, and hypertension, evidence supports cognitive-behavioral interventions and anti-diabetic, antilipidemic, and antihypertensive treatments.


CONCLUSIONS
Comprehensive care of individuals with mood disorders should include routine evaluation of the risk and presence of metabolic syndrome and its components. Systematic evaluation of preventative and targeted treatments of metabolic syndrome in mood disorder populations is insufficient.
Mood Disorders Psychopharmacology Unit, University Health Network, Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada. roger.mcintyre@uhn.on.ca
Roger S
RS
McIntyre
Mohammad
M
Alsuwaidan
Benjamin I
BI
Goldstein
Valerie H
VH
Taylor
Ayal
A
Schaffer
Serge
S
Beaulieu
David E
DE
Kemp
D026683:Advisory Committees; D019440:Anti-Obesity Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D050110:Bariatric Surgery / Q000523:psychology; D056912:Binge-Eating Disorder / Q000453:epidemiology / Q000628:therapy; D001714:Bipolar Disorder / Q000453:epidemiology / Q000628:therapy; D002170:Canada; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D050171:Dyslipidemias / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D008659:Metabolic Diseases / Q000453:epidemiology* / Q000628:therapy*; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000628:therapy; D019964:Mood Disorders / Q000453:epidemiology* / Q000628:therapy*; D009765:Obesity / Q000453:epidemiology / Q000628:therapy
D019440:Anti-Obesity Agents; D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants