title: Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments.
abstract: The Canadian Network for Mood and Anxiety Treatments (CANMAT) has revised its 2009 guidelines for the management of major depressive disorder (MDD) in adults by updating the evidence and recommendations. The target audiences for these 2016 guidelines are 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. "Psychological Treatments" is the second of six sections of the 2016 guidelines.
  
  
  
  Evidence-informed responses were developed for 25 questions under 5 broad categories: 1) patient characteristics relevant to using psychological interventions; 2) therapist and health system characteristics associated with optimizing outcomes; 3) descriptions of major psychotherapies and their efficacy; 4) additional psychological interventions, such as peer interventions and computer- and technology-delivered interventions; and 5) combining and/or sequencing psychological and pharmacological interventions.
  
  
  
  First-line psychological treatment recommendations for acute MDD include cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and behavioural activation (BA). Second-line recommendations include computer-based and telephone-delivered psychotherapy. Where feasible, combining psychological treatment (CBT or IPT) with antidepressant treatment is recommended because combined treatment is superior to either treatment alone. First-line psychological treatments for maintenance include CBT and mindfulness-based cognitive therapy (MBCT). Patient preference, in combination with evidence-based treatments and clinician/system capacity, will yield the optimal treatment strategies for improving individual outcomes in MDD.
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan Department of Psychiatry, University of Toronto, Toronto, Ontario parikhsa@umich.edu.
authors.forename: Sagar V
authors.initials: SV
authors.lastname: Parikh
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Lena C
authors.initials: LC
authors.lastname: Quilty
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Paula
authors.initials: P
authors.lastname: Ravitz
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenbluth
authors.affiliation: Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pavlova
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Sophie
authors.initials: S
authors.lastname: Grigoriadis
authors.affiliation: CBT Associates, Toronto, Ontario.
authors.forename: Vytas
authors.initials: V
authors.lastname: Velyvis
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
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, 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: 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: D002170:Canada; D003865:Major Depressive Disorder / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011613:Psychotherapy / Q000379:methods / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*
keywords: biopsychosocial; clinical practice guidelines; cognitive-behavioural therapy; evidence-based medicine; interpersonal therapy; major depressive disorder; meta-analysis; mindfulness-based interventions; psychotherapy; systematic reviews