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Journal Cover Canadian Journal of Psychiatry
  [SJR: 1.244]   [H-I: 79]   [16 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0706-7437 - ISSN (Online) 1497-0015
   Published by Sage Publications Homepage  [850 journals]
  • Updated CANMAT Guidelines for Treatment of Major Depressive Disorder
    • Authors: Patten; S. B.
      Pages: 504 - 505
      PubDate: 2016-08-17T13:20:44-07:00
      DOI: 10.1177/0706743716660034
      Issue No: Vol. 61, No. 9 (2016)
       
  • Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical
           Guidelines for the Management of Adults with Major Depressive Disorder:
           Introduction and Methods
    • Authors: Lam, R. W; Kennedy, S. H, Parikh, S. V, MacQueen, G. M, Milev, R. V, Ravindran, A. V, the CANMAT Depression Work Group
      Pages: 506 - 509
      PubDate: 2016-08-17T13:20:44-07:00
      DOI: 10.1177/0706743716659061
      Issue No: Vol. 61, No. 9 (2016)
       
  • 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
    • Authors: Lam, R. W; McIntosh, D, Wang, J, Enns, M. W, Kolivakis, T, Michalak, E. E, Sareen, J, Song, W.-Y, Kennedy, S. H, MacQueen, G. M, Milev, R. V, Parikh, S. V, Ravindran, A. V, the CANMAT Depression Work Group
      Pages: 510 - 523
      Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
      PubDate: 2016-08-17T13:20:44-07:00
      DOI: 10.1177/0706743716659416
      Issue No: Vol. 61, No. 9 (2016)
       
  • Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical
           Guidelines for the Management of Adults with Major Depressive Disorder:
           Section 2. Psychological Treatments
    • Authors: Parikh, S. V; Quilty, L. C, Ravitz, P, Rosenbluth, M, Pavlova, B, Grigoriadis, S, Velyvis, V, Kennedy, S. H, Lam, R. W, MacQueen, G. M, Milev, R. V, Ravindran, A. V, Uher, R, the CANMAT Depression Work Group
      Pages: 524 - 539
      Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
      PubDate: 2016-08-17T13:20:44-07:00
      DOI: 10.1177/0706743716659418
      Issue No: Vol. 61, No. 9 (2016)
       
  • Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical
           Guidelines for the Management of Adults with Major Depressive Disorder:
           Section 3. Pharmacological Treatments
    • Pages: 540 - 560
      Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
      PubDate: 2016-08-17T13:20:44-07:00
      DOI: 10.1177/0706743716659417
      Issue No: Vol. 61, No. 9 (2016)
       
  • Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical
           Guidelines for the Management of Adults with Major Depressive Disorder:
           Section 4. Neurostimulation Treatments
    • Authors: Milev, R. V; Giacobbe, P, Kennedy, S. H, Blumberger, D. M, Daskalakis, Z. J, Downar, J, Modirrousta, M, Patry, S, Vila-Rodriguez, F, Lam, R. W, MacQueen, G. M, Parikh, S. V, Ravindran, A. V, the CANMAT Depression Work Group
      Pages: 561 - 575
      Abstract: Background: 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. Methods: 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. "Neurostimulation Treatments" is the fourth of six sections of the 2016 guidelines. Results: Evidence-informed responses were developed for 31 questions for 6 neurostimulation modalities: 1) transcranial direct current stimulation (tDCS), 2) repetitive transcranial magnetic stimulation (rTMS), 3) electroconvulsive therapy (ECT), 4) magnetic seizure therapy (MST), 5) vagus nerve stimulation (VNS), and 6) deep brain stimulation (DBS). Most of the neurostimulation treatments have been investigated in patients with varying degrees of treatment resistance. Conclusions: There is increasing evidence for efficacy, tolerability, and safety of neurostimulation treatments. rTMS is now a first-line recommendation for patients with MDD who have failed at least 1 antidepressant. ECT remains a second-line treatment for patients with treatment-resistant depression, although in some situations, it may be considered first line. Third-line recommendations include tDCS and VNS. MST and DBS are still considered investigational treatments.
      PubDate: 2016-08-17T13:20:44-07:00
      DOI: 10.1177/0706743716660033
      Issue No: Vol. 61, No. 9 (2016)
       
  • 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
    • Authors: Ravindran, A. V; Balneaves, L. G, Faulkner, G, Ortiz, A, McIntosh, D, Morehouse, R. L, Ravindran, L, Yatham, L. N, Kennedy, S. H, Lam, R. W, MacQueen, G. M, Milev, R. V, Parikh, S. V, the CANMAT Depression Work Group
      Pages: 576 - 587
      Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
      PubDate: 2016-08-17T13:20:44-07:00
      DOI: 10.1177/0706743716660290
      Issue No: Vol. 61, No. 9 (2016)
       
  • Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical
           Guidelines for the Management of Adults with Major Depressive Disorder:
           Section 6. Special Populations: Youth, Women, and the Elderly
    • Authors: MacQueen, G. M; Frey, B. N, Ismail, Z, Jaworska, N, Steiner, M, Lieshout, R. J. V, Kennedy, S. H, Lam, R. W, Milev, R. V, Parikh, S. V, Ravindran, A. V, the CANMAT Depression Work Group
      Pages: 588 - 603
      Abstract: Background: 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. Methods: 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 on "Special Populations" is the sixth of six guidelines articles. Results: Recent studies inform the treatment of MDD in children and adolescents, pregnant and breastfeeding women, women in perimenopause or menopause, and the elderly. Evidence for efficacy of treatments in these populations is more limited than for the general adult population, however, and risks of treatment in these groups are often poorly studied and reported. Conclusions: Despite the limited evidence base, extant data and clinical experience suggest that each of these special populations can benefit from the systematic application of treatment guidelines for treatment of MDD.
      PubDate: 2016-08-17T13:20:44-07:00
      DOI: 10.1177/0706743716659276
      Issue No: Vol. 61, No. 9 (2016)
       
 
 
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