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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. 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 Levels of Evidence and expert clinical support. This section on "Pharmacotherapy" is one of 5 guideline articles. Results Despite emerging data on efficacy and tolerability differences amongst newer antidepressants, variability in patient response precludes identification of specific first choice medications for all patients. All second-generation antidepressants have Level 1 evidence to support efficacy and tolerability and most are considered first-line treatments for MDD. First-generation tricyclic and monoamine oxidase inhibitor antidepressants are not the focus of these guidelines but generally are considered second- or third-line treatments. For inadequate or incomplete response, there is Level 1 evidence for switching strategies and for add-on strategies including lithium and atypical antipsychotics. Limita…
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“Earlier reviews and meta-analyses and recent treatment guidelines for long-term treatment of MDD are generally supportive of treatments continued for several months as well as more than a year, particularly pharmacotherapies (Geddes et al., 2003; Lam et al., 2009; Pilling et al., 2009; Williams et al., 2009; Glue et al., 2010; Bauer et al., 2015).”
From Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials (2016) · cites this paper as Lam et al., 2009
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Suicide Rates in Short-term Randomized Controlled Trials of Newer Antidepressants
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Seasonal Affective Disorder and Its Prevention by Anticipatory Treatment with Bupropion XL
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“Two RCTs of augmentation with the CNS stimulant, methylphenidate, failed to detect differences in outcomes from placebo (Patkar et al., 2006; Ravindran et al., 2008) and a Cochrane systematic review found equivocal results for psychostimulants as augmentation to antidepressants (Candy et al.”
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Breastfeeding During Maternal Antidepressant Treatment With Serotonin Reuptake Inhibitors
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Influence of the CYP2D6 * 4 polymorphism on dose, switching and discontinuation of antidepressants
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To combine or not to combine? A literature review of antidepressant combination therapy
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Lithium Augmentation of Nortriptyline for Subjects Resistant to Multiple Antidepressants
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Discontinuation of Antidepressant Medication Among Latinos in the USA
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Pharmacological treatment for unipolar psychotic depression
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Do SSRIs or antidepressants in general increase suicidality?
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The effect of antidepressants on lipid homeostasis: a cardiac safety concern?
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Is there evidence for negative effects of antidepressants on suicidality in depressive patients?
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Weight Gain in Breastfed Infants of Mothers Taking Antidepressant Medications
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Systematic Overview of Drug Interactions with Antidepressant Medications
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Does Paroxetine Cause Cardiac Malformations?
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Pindolol Augmentation in Depressed Patients Resistant to Selective Serotonin Reuptake Inhibitors
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The onset of effect for escitalopram and its relevance for the clinical management of depression
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The Effect of Antidepressant Warnings on Prescribing Trends in Ontario, Canada
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A Survey of Combination Antidepressant Use in Australia
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Antidepressant Drug-Drug Interaction Profile Update
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Self-citation
Flagged first, then by citations
2 of the 150 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Lam, 2004, Prescribing antidepressants for depression in 2005: recent concerns and recommendations, Can. J. Psychiatry, 49, 1
Cited by
Sorted by citations
Kennedy, S. H., Lam, R. W., McIntyre, R. S., Tourjman, S. V., Bhat, V., Blier, P., Hasnain, M., Jollant, F., Levitt, A. J., MacQueen, G. M., et al. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716659417 · Cited by 1,181
Self-citationMalhi, G. S., Bassett, D., Boyce, P., Bryant, R., Fitzgerald, P. B., Fritz, K., Hopwood, M., Lyndon, B., Mulder, R., Murray, G., et al. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867415617657 · Cited by 842
“Earlier studies that examined T3 augmentation of tricyclic antidepressants had mixed results (Lam et al., 2009), and systematic review of T3 augmentation of SSRIs (Cooper-Kazaz and Lerer, 2008) provides equivocal evidence for its efficacy.”
Bauer, M., Pfennig, A., Severus, E., Whybrow, P. C., Angst, J., Möller, H.-J., & Šon behalf of the Task Force on Unipolar Depressive Disorders (2013) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2013.804195 · Cited by 632
Berlim, M. T., van den Eynde, F., Tovar-Perdomo, S., & Daskalakis, Z. J. (2014) · Psychological Medicine · doi:10.1017/s0033291713000512 · Cited by 620
Evidence-based clinical guidelines for immigrants and refugees
Pottie, K. C., Greenaway, C., Feightner, J., Welch, V. A., Swinkels, H. M., Rashid, M., Narasiah, L., Kirmayer, L. J., Ueffing, E., MacDonald, N., et al. (2010) · Canadian Medical Association Journal · doi:10.1503/cmaj.090313 · Cited by 555
Metadata
- Authors
- Lam, R. W., Kennedy, S. H., Grigoriadis, S., McIntyre, R. S., Milev, R., Ramasubbu, R., Parikh, S. V., Patten, S. B., & Ravindran, A. V.
- Affiliations
- University of British Columbia (CA)
- University of Toronto (CA)
- Queen's University (CA)
- University of Calgary (CA)
- Corresponding author
- Lam, Raymond W.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 117
- Pages
- S26-S43
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W38793130
- Cited by
- 431
- References
- 150
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 8 · 2023: 9 · 2022: 13 · 2021: 15 · 2020: 16 · 2019: 18 · 2018: 24 · 2017: 27 · 2016: 41 · 2015: 55 · 2014: 43 · 2013: 49 · 2012: 55
- FWCI
- 24.76
- 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 (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, antidepressant treatment, second-generation antidepressants, first-line therapy, inadequate response, switching strategy, adjunctive therapy, lithium, atypical antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors, treatment-resistant depression, adults
- MeSH terms
- Suicide Prevention, Adult, Antidepressive Agents, Depressive Disorder, Major, Major Depressive Disorder, Drug Interactions, Humans, Sexual Dysfunction, Physiological, Selective Serotonin Reuptake Inhibitors, Antidepressive Agents, Second-Generation
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