Research reportCanadian Network for Mood and Anxiety Treatments (CANMAT) Clinical Guidelines for the Management of Major Depressive Disorder in Adults. I. Classification, Burden and Principles of Management
Introduction
The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT), a not-for-profit scientific and educational organization, collaborated on the publication in 2001 of evidence-based Canadian clinical guidelines for the treatment of depressive disorders (Kennedy and Lam, 2001). A revision of these guidelines was undertaken by CANMAT in 2008–2009 to update the recommendations based on new evidence. The scope of these guidelines encompasses the management of adults with unipolar major depressive disorder (MDD). This section on classification, burden and principles of treatment is one of 5 guideline articles. There are separate CANMAT guidelines for Bipolar Disorder (Yatham et al., 2009).
The current classification of depressive disorders is based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 2000) or “Recurrent Depressive Episodes” in the ICD-10 Classification of Mental and Behavioral Disorders (http://www.who.int/classifications/icd/en/). In neither case are these diagnoses linked to etiopathology. MDD is associated with a substantial health, psychosocial and financial burden and is increasingly recognized as a target for chronic disease management. While standardized diagnostic criteria are available, clinical assessment must extend beyond application of these criteria. It is important to consider the short term and long-term components of management and these will be expanded upon in subsequent sections of the guidelines, dealing with psychotherapies, pharmacotherapies, neurostimulation therapies and complementary and alternative medicines. The recommendations are presented as guidance for clinicians who should consider them in context of individual patients, and not as standards of care.
Section snippets
Methods
The full methods have been described elsewhere (Kennedy et al, 2009-this issue) but, in summary, relevant English language publications from January 1, 2000 to December 31, 2008 were identified using computerized searches of electronic databases (PubMed, PsychInfo, Cochrane Register of Clinical Trials), inspection of bibliographies, and review of other guidelines and major reports. The previous question–answer format has been retained based on feedback from clinicians. Recommendations for each
Conclusion
Depressive disorders are among the most common and burdensome conditions afflicting the Canadian population. Evidence-based management can reduce their burden in afflicted individuals and ultimately in society as a whole. By summarizing an updated evidence base, the aim of these revised CANMAT guidelines is to link the best available evidence to the best possible care of depressed patients.
Conflict of interest
No conflict declared.
Role of funding sources
These guidelines were entirely funded with funding from the Canadian Network for Mood and Anxiety Treatments; no external funds were sought or received.
SBP is on Speaker/Advisory Boards for, or has received research funds from: Cipher Pharmaceuticals, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Norlein Foundation, and Servier.
SHK is on Speaker/Advisory Boards for, or has received research funds from: Advanced Neuromodulation Systems Inc.,
Acknowledgements
CANMAT thanks the external reviewers: Alain LeSage, MD, FRCPC (University of Montreal), and Jitender Sareen, MD, FRCPC (University of Manitoba).
References (92)
- et al.
Cytokines and depression: an analogic approach
Biomed. Pharmacother.
(2002) The integration of cardiovascular behavioral medicine and psychoneuroimmunology: new developments based on converging research fields
Brain Behav. Immun.
(2003)- et al.
Inflammation and coagulation factors in persons > 65 years of age with symptoms of depression but without evidence of myocardial ischemia
Am. J. Cardiol.
(2002) - et al.
Screening for depression in medical care: pitfalls, alternatives, and revised priorities
J. Psychosom. Res.
(2003) - et al.
Major depression as a risk factor for chronic disease incidence: longitudinal analyses in a general population cohort
Gen. Hosp. Psychiatry
(2008) - et al.
Inflammatory markers and depressed mood in older persons: results from the Health, Aging and Body Composition study
Biol. Psychiatry
(2003) - et al.
The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression
Biol. Psychiatry
(2003) - et al.
Which presenteeism measures are more sensitive to depression and anxiety?
J. Affect. Disord.
(2007) - et al.
Job performance deficits due to depression
Am. J. Psychiatry
(2006) - et al.
Coronary and aortic calcification in women with a history of major depression
Arch. Intern. Med.
(2005)