Journal
JOURNAL OF AFFECTIVE DISORDERS
Volume 117, Issue -, Pages S26-S43Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jad.2009.06.041
Keywords
Depressive disorders; MDD; Antidepressant; Pharmacotherapy; Canadian; Guidelines; Systematic review; Treatment; Adverse effects; Treatment-resistant depression
Categories
Funding
- Canadian Network for Mood and Anxiety Treatments
- Advanced Neuromodulation Systems Inc.
- AstraZeneca
- BrainCells Inc.
- Biovail
- Canadian Institutes of Health Research
- Canadian Psychiatric Research Foundation
- Eli Lilly
- Janssen
- Litebook Company Ltd.
- Lundbeck
- Lundbeck Institute
- Mathematics of Information Technology and Advanced Computing Systems
- Michael Smith Foundation for Health Research
- Servier
- Takeda
- UBC Institute of Mental Health/Coast Capital Savings
- Wyeth
- Boehringer-Ingelhem
- GlaxoSmithKline
- Janssen-Ortho
- Merck Frosst
- CR Younger Foundation
- Ontario Mental Health Foundation
- Organon
- Pfizer
- France Foundation
- I3CME
- Physicians' Postgraduate Press
- Schering-Plough
- Shire
- Solvay/Wyeth
- Alberta Medical Services Incorporated
- Calgary Health Region
- Hotchkiss Brain Institute
- University of Calgary
- Apotex
- Novartis
- Cipher Pharmaceuticals
- Norlein Foundation
- Roche
Ask authors/readers for more resources
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. Limitations: Most of the evidence is based on trials for registration and may not reflect real-world effectiveness. Conclusions: Second-generation antidepressants are safe, effective and well tolerated treatments for MDD in adults. Evidence-based switching and add-on strategies can be used to optimize response in MDD that is inadequately responsive to monotherapy. (C) 2009 Published by Elsevier B.V.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available