Symposium​​ 
S04 -​​ 
Canadian Network for Mood and Anxiety Treatments (CANMAT): Update of Novel Treatments and Approaches for Bipolar Disorder​​ 

Saturday, 24 October​​ 
13:30 – 16:45 (3 hrs plus 15 min break
)
Roumen Milev*, MD, FRCPC; Lakshmi Yatham, MD, FRCPC; Valerie Taylor, MD, PhD, FRCPC; Trisha Chakrabarty, MD; Elisa Brietzke, MD​​ 

 

CanMEDS Roles:​​ 

  • Medical Expert​​ 

  • Scholar​​ 

  • Collaborator​​ 

At the end of this session, participants will be able to:​​ 1) Describe the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for bipolar disorders; 2) List novel treatments for bipolar disorders; and 3) Discuss new approaches for treatment options.​​ 

The Canadian Network for Mood and Anxiety Treatments (CANMAT) is a network of academic and clinical experts dedicated to improving clinical care for people with mood and anxiety disorders. We provide up-to-date scientific information, treatment guidelines, and educational activities for health professionals, as well as clear and useful information about symptoms and treatments for patients and families. In this symposium, we are going to approach emergent treatments for bipolar disorder, aiming to discuss both their potential and controversies. The main objective is to translate the most consistent research findings on new therapeutic targets to the evidence that can improve clinical practice.

S04a - Learnings From the Literature: An Evidence-Informed Review of the Bipolar and Microbiome Clinical Data
Valerie Taylor*, MD, PhD, FRCPC​​ 

At the end of this session, participants will be able to:​​ 1) Understand the results of a detailed meta-analysis and systematic review examining all clinical data on the current clinical literature as it pertains; 2) Identify evidenced-based recommendations, based on current clinical information, regarding how microbial therapies should be viewed in the context of; and 3) Discuss the next steps with respect to the role of the microbiome in treating bipolar disorder.​​ 

According to PubMed, the number of articles that include “gut microbiome” or “gut microbiota” in the title showed exponential growth over the past decade, with only 37 articles in 2008 and 1,537 in 2018. Incredibly, this is an over 4,000% increase. Most of this work is preclinical, but there is an ever-growing body of compelling, albeit inconsistent quality, work translating it into a clinical population. The results of this translation can vary widely, and two recent meta-analyses examining the role of the microbiome in depression gave conflicting results. Understanding how to recommend this work as it pertains to both clinical care and how it informs research questions can be challenging.

References:

  • Dinan TG, Cryan JF. Gut microbiota: a missing link in psychiatry. World Psychiatry 2020;19(1):111–12.

  • Bastiaanssen TFS, Cussotto S, Claesson MJ, et al. Gutted! Unraveling the role of the microbiome in major depressive disorder. Harv Rev Psychiatry 2020;28(1):26–39.

S04b - Canadian Network for Mood and Anxiety Treatments / International Society for Bipolar Disorders Guidelines for Bipolar Disorder With Mixed Features
Trisha Chakrabarty*, MD​​ 

At the end of this session, participants will be able to:​​ 1) Describe the quality and level of evidence supporting current treatment recommendations for DSM-5–defined mood episodes with mixed features; 2) Name two evidence-based pharmacological treatments for the acute treatment of DSM-5–defined mania with mixed features and depression with mixed features; and 3) Name one evidence-based pharmacological treatment for the long-term prevention of mixed symptoms.​​ 

The DSM-5 removed the mixed episode and introduced a mixed-features specifier that applies to manic, hypomanic, and depressive episodes in bipolar disorder (BD). The Canadian Network for Mood and Anxiety Treatments (CANMAT), in collaboration with the ISBD, assembled a group of Canadian and international bipolar experts to review the evidence and develop treatment recommendations for people with BD with mixed features. As a part of the process, the CANMAT/ISBD group conducted a systematic review to identify and categorize the evidence and applied pre-specified criteria to categorize the evidence for each treatment. The evidence from clinical trials was considered in concert with the safety and tolerability and risk of a treatment-emergent switch to develop first-, second-, and third-line treatment recommendations for this population.

References:

  • Rosenblat JD, McIntyre RS. Treatment recommendations for DSM-5 defined mixed features. CNS Spectrums 2016;22:147–54.

  • Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018;20:97–170.

S04c - Novel Treatments and Approaches: Ketamine
Elisa Brietzke*, MD​​ 

At the end of this session, participants will be able to:​​ 1) Describe the rationale for the use of intravenous ketamine in treatment-resistant depression; 2 ) List the mechanisms of action,​​ expected therapeutic effects, and potential side effects of intravenous ketamine; and 3) Describe the therapeutic usefulness of ketamine.​​ 

Ketamine is a medication traditionally used in anesthesia that was repurposed as a rapid-action antidepressant. After its introduction in the treatment of mood disorders, ketamine became a therapeutically useful option for treatment-resistant unipolar depression and bipolar depression, as well. In this presentation, the following topics will be reviewed: pharmacological properties of ketamine, protocols of administration, predictors of response, structure and functioning of a ketamine clinic, and limitations and future developments.

References:

  • Ibrahim L, DiazGranados N, Franco-Chaves J, et al. Course of improvement in depressive symptoms to a single intravenous infusion of ketamine vs add-on riluzole: results from a 4-week, double-blind, placebo-controlled study. Neuropsychopharmacology 2012;37:1526–33.

  • Fond G, Loundou A, Rabu C, et al. Ketamine administration in depressive disorders: a systematic review and meta-analysis. Psychopharmacology 2014;231:3663–76.

/ Virtual Conference 2020