Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 4. Neurostimulation Treatments
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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.
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rTMS is approved and used clinically as a treatment for medication-resistant depression in various jurisdictions.
“rTMS is now approved and used clinically as a treatment for medication-resistant depression in a variety of jurisdictions around the world (Lefaucheur et al., 2014; Milev et al., 2016; Perera et al., 2016).”
From Cortico-striatal-thalamic loop circuits of the salience network: A central pathway in psychiatric disease and treatment (2016) · cites this paper as Milev et al., 2016
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Self-citation
- 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
- Affiliations
- Queen's University (CA)
- University of Toronto (CA)
- University of Manitoba (CA)
- Université Laval (CA)
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
- University of British Columbia (CA)
- University of Calgary (CA)
- Corresponding author
- Milev, Roumen V.
- ORCID
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2016-08-11
- Volume
- 61
- Issue
- 9
- Pages
- 561-575
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC4994792
- OpenAlex
- W4236675028
- Cited by
- 586
- References
- 98
- Citations by year
- 2026: 35 · 2025: 56 · 2024: 71 · 2023: 58 · 2022: 89 · 2021: 74 · 2020: 67 · 2019: 64 · 2018: 38 · 2017: 28 · 2016: 6
- FWCI
- 36.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Fondation Brain Canada
- Sunovion
- University Health Network
- Campbell Institute
- Valeant Pharmaceuticals International
- Canadian Network for Mood and Anxiety Treatments
- Centre for Addiction and Mental Health Foundation
- BrainsWay
- Queen's University
- Grand Challenges Canada
- Ministero dello Sviluppo Economico
- Vancouver Coastal Health Research Institute
- Servier
- H. Lundbeck A/S
- National Institutes of Health
- St. Jude Medical
- Allergan
- University Health Network Foundation
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- major depressive disorder, neurostimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, electroconvulsive therapy, magnetic seizure therapy, vagus nerve stimulation, deep brain stimulation, treatment-resistant depression, antidepressant-refractory depression, CANMAT guidelines
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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