title: Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 1. Disease Burden and Principles of Care.
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. This section is the first of six guidelines articles.
  
  
  
  In Canada, the annual and lifetime prevalence of MDD was 4.7% and 11.3%, respectively. MDD represents the second leading cause of global disability, with high occupational and economic impact mainly attributable to indirect costs. DSM-5 criteria for depressive disorders remain relatively unchanged, but other clinical dimensions (sleep, cognition, physical symptoms) may have implications for depression management. e-Mental health is increasingly used to support clinical and self-management of MDD. In the 2-phase (acute and maintenance) treatment model, specific goals address symptom remission, functional recovery, improved quality of life, and prevention of recurrence.
  
  
  
  The burden attributed to MDD remains high, whether from individual distress, functional and relationship impairment, reduced quality of life, or societal economic cost. Applying core principles of care, including comprehensive assessment, therapeutic alliance, support of self-management, evidence-informed treatment, and measurement-based care, will optimize clinical, quality of life, and functional outcomes in MDD.
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia r.lam@ubc.ca.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
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, University of Calgary, Calgary, Alberta.
authors.forename: JianLi
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba.
authors.forename: Murray W
authors.initials: MW
authors.lastname: Enns
authors.affiliation: Department of Psychiatry, McGill University, Montréal, Quebec.
authors.forename: Theo
authors.initials: T
authors.lastname: Kolivakis
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Michalak
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba.
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Song
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 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
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Arun V
authors.initials: AV
authors.lastname: Ravindran
mesh_terms: D002170:Canada; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*
keywords: clinical assessment; clinical practice guidelines; depressive disorders; diagnosis; evidence-based medicine; major depressive disorder; meta-analysis; phenomenology; systematic reviews