title: Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine 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. "Complementary and Alternative Medicine Treatments" is the fifth of six sections of the 2016 guidelines.
  
  
  
  Evidence-informed responses were developed for 12 questions for 2 broad categories of complementary and alternative medicine (CAM) interventions: 1) physical and meditative treatments (light therapy, sleep deprivation, exercise, yoga, and acupuncture) and 2) natural health products (St. John's wort, omega-3 fatty acids; S-adenosyl-L-methionine [SAM-e], dehydroepiandrosterone, folate, Crocus sativus, and others). Recommendations were based on available data on efficacy, tolerability, and safety.
  
  
  
  For MDD of mild to moderate severity, exercise, light therapy, St. John's wort, omega-3 fatty acids, SAM-e, and yoga are recommended as first- or second-line treatments. Adjunctive exercise and adjunctive St. John's wort are second-line recommendations for moderate to severe MDD. Other physical treatments and natural health products have less evidence but may be considered as third-line treatments. CAM treatments are generally well tolerated. Caveats include methodological limitations of studies and paucity of data on long-term outcomes and drug interactions.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario arun.ravindran@camh.ca.
authors.forename: Arun V
authors.initials: AV
authors.lastname: Ravindran
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Lynda G
authors.initials: LG
authors.lastname: Balneaves
authors.affiliation: School of Kinesiology, University of British Columbia, Vancouver, British Columbia.
authors.forename: Guy
authors.initials: G
authors.lastname: Faulkner
authors.affiliation: Department of Psychiatry, University of Ottawa, Ottawa, Ontario.
authors.forename: Abigail
authors.initials: A
authors.lastname: Ortiz
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, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Morehouse
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ravindran
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
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 Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sagar V
authors.initials: SV
authors.lastname: Parikh
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods / Q000592:standards*; D001688:Biological Products / Q000627:therapeutic use*; D002170:Canada; D003865:Major Depressive Disorder / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000592:standards*; D005081:Exercise Therapy / Q000379:methods / Q000592:standards*; D006801:Humans; D010789:Phototherapy / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012892:Sleep Deprivation
chemical_list: D001688:Biological Products
keywords: clinical practice guidelines; complementary and alternative medicine; evidence-based medicine; exercise; light therapy; major depressive disorder; meta-analysis; natural health products; sleep deprivation; systematic reviews