Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes
CANMAT · 2024 · Canada
Source and licence
- Authors
- Raymond W. Lam, Sidney H. Kennedy, Camelia Adams et al.
- Title
- Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes
- Journal
- Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11351064
Licence statement of the original publication
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Abstract
Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults.
Methods: CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process.
Results: The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted.
Conclusions: The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Evidence Review
- Grading of Recommendations
- Feedback and Consensus Process
- Caveats and Limitations
- Conventions Used in This Document
- Question 1. What are Important Issues for Assessment and Diagnosis?
- What are the Risk Factors for MDD?
- How and Who Should Be Screened for Depression?
- What Screening Tools can be Used?
- What Factors are Important in Assessment and Diagnosis?
- What are Diagnostic Specifiers and Symptom Dimensions?
- How can Access for Equity Deserving Groups be Improved?
- Question 2. What are the Principles for Depression Management?
- What are the Phases and Objectives of Treatment?
- Why is Symptom Remission Important?
- How are Suicide and Safety Risks Managed?
- What is the Role of Patient Preference?
- How Does Treatment Cost and Access Influence Management?
- What Lifestyle Interventions are Effective?
- Who Delivers and Monitors Care?
- Question 3. How are Treatments Selected?
- How is the Initial Treatment Selected?
- When Should Pharmacotherapy and Psychotherapy be Combined?
- How is a Psychological Treatment Selected?
- How Many Sessions of Psychological Treatment are Required?
- How is a Pharmacological Treatment Selected?
- Which Treatments Have New Evidence?
- How do DSM-5-TR Specifiers and Symptom Dimensions Influence Medication Selection?
- Are Antidepressants Associated With an Increased Risk of Suicide?
- Are There Differences in Formulations of Specific Antidepressants?
- What are the Safety Concerns and Drug Interactions With Antidepressants?
- Can Pharmacogenetic Testing Inform Medication Selection?
- Can Other Biomarkers Inform Treatment Selection?
- What Complementary and Alternative Medicine Treatments are Effective?
- How are Comorbid Conditions Managed?
- How are Cultural and Religious Practices Integrated Into Treatment?
- Question 4. What is the Role of DHIs?
- What are DHIs?
- What are Best Practices for Evaluating DHIs?
- What is the Difference Between Guided and Unguided DHIs?
- What are Examples of Guided (Facilitated) DHIs?
- What are Examples of Unguided (Self-Directed) DHIs?
- Question 5. How is Treatment Monitored?
- What is Measurement-Based Care?
- What are Operational Definitions for Improvement, Response, and Remission?
- How is Measurement-Based Care Implemented?
- What Laboratory Tests Should be Monitored During Treatment?
- Question 6. What Should be Done When a Patient is Better?
- How is Remission Maintained?
- How is Recurrence Prevented?
- Who Needs Longer-Term Antidepressant Treatment?
- How Should Antidepressant Treatment be Discontinued?
- Question 7. What Should be Done When a Patient is not Better?
- What Contributes to a Poor Response to Treatment?
- What is the Difference Between Treatment-Resistant Depression and Difficult-to-Treat Depression?
- How are Strategies Sequenced When There is a Poor Response to an Initial Antidepressant Treatment?
- When and how Should Antidepressants be Switched?
- What are the Benefits and Drawbacks of Adding an Adjunctive Medication?
- How is an Adjunctive Medication Selected?
- What are the Risks and Benefits of Specific Adjunctive Medications?
- What Psychological Treatments are Effective After Poor Response to the Initial Antidepressant?
- Question 8. When Should Neuromodulation Treatments be Used?
- What are Neuromodulation Treatments?
- What Noninvasive Neuromodulation Treatments are Available?
- What Surgical Neuromodulation Treatments are Available?
- When Should Neuromodulation Treatments be Selected?
- Conclusions
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