Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults.
Abstract
Background In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field. There is widespread interest in complementary and alternative medicine (CAM) therapies in the treatment of major depressive disorder (MDD). Methods The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. This section on "Complementary and Alternative Medicine Treatments" is one of 5 guideline articles. Results There is Level 1 evidence to support light therapy in seasonal MDD and St. John's wort in mild to moderate MDD. There is also some evidence for the use of exercise, yoga and sleep deprivation, as well as for omega-3 fatty acids and SAM-e . Support for other natural health products and therapies is still limited. Limitations The evidence base remains limited and studies often have methodological problems, including small samples, variability in dose, short duration of treatment, unknown quality of the agent and limited long-term data.…
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Many global guidelines and recommendations for the treatment of depression advocate the use of high-intensity light therapy as an effective treatment approach.
“Furthermore, many global guidelines and recommendations for the treatment of depression advocate the use of high-intensity light therapy as an effective treatment approach.[52–54]”
From Effectiveness of visible light for seasonal affective disorder: A systematic review and network meta-analysis (2025) · cites this paper as [54]
International guidelines recommend inclusion of exercise as first-line treatment for patients with mental illness, particularly sub-threshold or mild to moderate depression, or as an adjunct to pharmacotherapy for mild to moderate depression.
“International guidelines, developed subsequent to those currently in place in Australia, recommend the inclusion of exercise as fi rst-line treatment of patients with mental illness, particularly for those with sub-threshold or mild to moderate depression (National Institute for Health and Care Excellence 2009) or as an adjunct to pharmacotherapy for patients with mild to moderate depression (Rav”
From A call to action: Exercise as treatment for patients with mental illness (2015) · cites this paper as Ravindran et al. 2009
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“Drawing on this early evidence, Canadian guidelines for depression treatment recommend DHEA as a potential treatment option when other options have failed (Ravindran et al., 2009).”
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“These treatments are generally well tolerated and include exercise, light therapy, mindfulness-based meditation, omega-3 fatty acids and yoga (Ravindran et al., 2009).”
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“In addition to synthetic antidepressants, there are also herbal medicinal products that have been thought to help control depression and other mental disorder conditions in recent years (Deligiannidis and Freeman, 2010; Ravindran et al., 2009).”
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“Augmenting options have been more extensively studied but conclusions are still limited by small sample sizes and lack of placebo controls.(44) A review of 10 studies”
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Allan, C. L., & Ebmeier, K. P. (2013) · Advances in Psychiatric Treatment · doi:10.1192/apt.bp.112.010835 · Cited by 25 · see citing works
Yoga and Mental Health: A Review
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“The Canadian Network for Mood and Anxiety Treatment (CANMAT) clinical guidelines for the management of depressive disorder in adults [14] recommend different strategies (switch or add-on) and different agents (e.”
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BackgroundAntipsychotic augmentation for major depressive disorder: A review of clinical practice guidelines.
Simons, P., Cosgrove, L., Shaughnessy, A., & Bursztajn, H. (2017) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2017.10.003 · Cited by 23 · see citing works
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“There is growing evidence for the efficacy of combined chronotherapeutic interventions as adjunctive treatments for major depression (Ravindran et al. 2009; Wirz-Justice et al. 2005; Wirz-Justice et al. 2013).”
BackgroundClinical Handbook for the Management of Mood Disorders
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“The Canadian Network for Mood and Anxiety Treatments (CANMAT) declare SJW to have high level evidence and so supports the first-line use of SJW for mild-to-moderate depression.([60]) Although the British Columbia Ministry of Health does not even mention SJW in its guidelines, and the most recent CANMAT guidelines also…”
BackgroundCosgrove, L., Shaughnessy, A., Peters, S. M., Lexchin, J., Bursztajn, H., & Bero, L. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000458727 · Cited by 20 · see citing works
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“There is also evidence for the addition of aripiprazole, quetiapine, risperidone, and olanzapine for treatment-resistant depression, [31] which often presents as a complicating factor in military-related, chronic PTSD.”
BackgroundWake-Promoting Pharmacotherapy for Psychiatric Disorders
Dell'Osso, B., Dobrea, C., Cremaschi, L., Arici, C., & Altamura, A. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-014-0524-2 · Cited by 18 · see citing works
Getting depression clinical practice guidelines right: time for change?
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Hypericum extract WS® 5570 for depression – An overview
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“…favourable safety profi le Hypericum extract preparations have been recommended for the treatment of depression by several national disease management guidelines (e.g., Freeman et al. 2010; H ä rter et al. 2010; Ravindran et al. 2009) as well as for pharmacoeconomic reasons (Solomon et al. 2011).”
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“Most recent international treatment guidelines [35,36] further, recommend limiting the use of BDZs only in patients with primary major depression to those with pronounced anxiety or persistent insomnia that are not adequately relieved by ADs.”
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“Light therapy and antidepressants are now recommended as first-line treatments for SAD in several clinical guidelines including the Canadian Network for Mood and Anxiety Treatments (CANMAT) [9], the American Psychiatric Association [10], the British Association of Psychopharmacology [11], and the World Federation of S…”
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Depressive Disorders: Mechanisms, Measurement and Management
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“…the authors of this paper recognize that clinical guidelines in Canada recommend CBT as a first-line intervention for depression and anxiety (Ravindran et al., 2009; Swinson et al., 2006), our clinical experience with group CBT suggests that the most significant drawback to CBT is the lack…”
BackgroundBupropion for the treatment of seasonal affective disorder
Niemegeers, P., Dumont, G., Patteet, L., Neels, H., & Sabbe, B. (2013) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1517/17425255.2013.804062 · Cited by 13 · see citing works
“It consists of daily exposure to bright light, usually with an intensity of 10,000 lux for 30 min, administered early in the morning [7].”
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“These guidelines were revised in 2009 [35-40], and the most recent revised version was published in 2016 (CANMAT 2016) [1,12,41-45].”
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“Pharmacological treatment employs drugs to reduce psychiatric symptoms, and its effectiveness varies across disorders and medications with adverse outcomes, such as dry mouth, headache, or nausea, which can hamper the quality of life (Cheon et al. 2015; Damsker et al. 2009).”
BackgroundWork functioning impairment in the course of pharmacotherapy treatment for depression
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“Some maintain that it is the first-line therapy for SAD [15, 16], but in Sweden it is not approved as an evidence-based treatment [17].”
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- Authors
- Ravindran, A. V., Lam, R. W., Filteau, M. J., Lespérance, F., Kennedy, S. H., Parikh, S. V., & Patten, S. B.
- Affiliations
- University of Toronto (CA)
- University of British Columbia (CA)
- Université Laval (CA)
- Université de Montréal (CA)
- University of Calgary (CA)
- Corresponding author
- Ravindran, Arun V.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 117
- Pages
- S54-S64
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W1746601541
- Cited by
- 108
- References
- 0
- Citations by year
- 2025: 5 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 3 · 2020: 3 · 2019: 6 · 2018: 5 · 2017: 9 · 2016: 17 · 2015: 7 · 2014: 10 · 2013: 13 · 2012: 12
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Network for Mood and Anxiety Treatments
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- major depressive disorder, complementary and alternative medicine, phototherapy, seasonal affective disorder, Hypericum perforatum, physical activity, yoga, sleep deprivation, omega-3 fatty acids, natural health products, treatment lines, depression treatment
- MeSH terms
- Adult, Complementary Therapies, Antidepressive Agents, Dehydroepiandrosterone, Major Depressive Disorder, Exercise Therapy, Humans, Phytotherapy, Phototherapy, S-Adenosylmethionine, Sleep Deprivation, Tryptophan, Yoga, Fatty Acids, Omega-3, Acupuncture Therapy, Dietary Supplements, Hypericum, Herbal Medicine
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