Journal
JOURNAL OF AFFECTIVE DISORDERS
Volume 117, Issue -, Pages S54-S64Publisher
ELSEVIER
DOI: 10.1016/j.jad.2009.06.040
Keywords
Major depressive disorder; Canadian Network for Mood and Anxiety Treatments (CANMAT); Complimentary and Alternative Medicine Light therapy; Exercise therapy; Nutraceutical therapies
Categories
Funding
- Canadian Network for Mood and Anxiety Treatments
- AstraZeneca
- Cephalon
- Eli Lilly
- GlaxoSmithKline
- Janssen-Ortho
- Lundbeck
- Pfizer
- Roche
- Servier
- Wyeth
- Advanced Neuromodulation Systems Inc.
- BrainCells Inc.
- Biovail
- Canadian Institutes of Health Research
- Canadian Psychiatric Research Foundation
- Janssen
- Litebook Company Ltd.
- Lundbeck Institute
- Mathematics of Informatics Technology and Advanced Computing Systems
- Michael Smith Foundation for Health Research
- Takeda
- UBC Institute of Mental Health/Coast Capital Savings
- Bristol-Myers-Squibb
- Janssen Ortho
- Servier Canada
- Isodis Natura
- Advanced Neuromodulation Systems Inc
- Boehringer-Ingelhem
- Brain Cells Inc
- Merck Frost
- Apotex
- Lilly
- Novartis
- Cipher Pharmaceuticals
- Norlein Foundation
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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. Safety data are also sparse with little information about drug interactions. Conclusions: Some CAM treatments have evidence of benefit in MDD. However, problems with standardization and safety concerns may limit their applicability in clinical practice. (C) 2009 Published by Elsevier B.V.
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