title: Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments.
abstract: 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.
  
  
  
  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.
  
  
  
  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 frequent monitoring, and assessing clinical and functional outcomes with measurement-based care; 2) comparative aspects of antidepressant medications based on efficacy, tolerability, and safety, including summaries of newly approved drugs since 2009; 3) practical approaches to pharmacological management, including drug-drug interactions and maintenance recommendations; and 4) managing inadequate response and treatment resistance, with a focus on switching antidepressants, applying adjunctive treatments, and new and emerging agents.
  
  
  
  Evidence-based pharmacological treatments are available for first-line treatment of MDD and for management of inadequate response. However, given the limitations of the evidence base, pharmacological management of MDD still depends on tailoring treatments to the patient.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario *Co-first authors. sidney.kennedy@uhn.ca.
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia *Co-first authors.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.affiliation: Department of Psychiatry, L'Université de Montréal, Montréal, Quebec.
authors.forename: S Valérie
authors.initials: SV
authors.lastname: Tourjman
authors.affiliation: Department of Psychiatry, McGill University, Montréal, Quebec.
authors.forename: Venkat
authors.initials: V
authors.lastname: Bhat
authors.affiliation: Department of Psychiatry, University of Ottawa, Ottawa, Ontario.
authors.forename: Pierre
authors.initials: P
authors.lastname: Blier
authors.affiliation: Department of Psychiatry, Memorial University, St. John's, Newfoundland.
authors.forename: Mehrul
authors.initials: M
authors.lastname: Hasnain
authors.affiliation: Department of Psychiatry, McGill University, Montréal, Quebec.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Jollant
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Levitt
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta.
authors.forename: Glenda M
authors.initials: GM
authors.lastname: MacQueen
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Shane J
authors.initials: SJ
authors.lastname: McInerney
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
authors.forename: Diane
authors.initials: D
authors.lastname: McIntosh
authors.affiliation: Department of Psychiatry, Queen's University, Kingston, Ontario.
authors.forename: Roumen V
authors.initials: RV
authors.lastname: Milev
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Müller
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sagar V
authors.initials: SV
authors.lastname: Parikh
authors.affiliation: Canadian Pharmacists Association, Ottawa, Ontario.
authors.forename: Norma L
authors.initials: NL
authors.lastname: Pearson
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Arun V
authors.initials: AV
authors.lastname: Ravindran
authors.affiliation: Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Uher
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D002170:Canada; D003865:Major Depressive Disorder / Q000188:drug therapy*; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*
chemical_list: D000928:Antidepressive Agents
keywords: antidepressants; antipsychotics; clinical practice guidelines; clinical trials; evidence-based medicine; major depressive disorder; meta-analysis; pharmacotherapy; randomized controlled trial