Friday, Oct. 20
10:45 – 11:45 (1 hr)
Meeting Room: Pavilion Ballroom D (3rd floor – North Tower)
Raymond Lam*, MD; Sidney Kennedy, MD; Anees Bahji, MD; Elisa Brietzke, MD, PhD; André Do, MDCM; Lena Quilty, PhD

CanMEDS Roles:

1. Medical Expert
2. Professional
3. Scholar

At the end of this session, participants will be able to: 1) Describe the evidence review process and criteria used for the Canadian Network for Mood and Anxiety Treatments depression guidelines 2023 update; 2) Discuss the limitations of the clinical evidence and the advantages and disadvantages of expert consensus in developing evidence-based recommendations; and 3) Discuss four updated recommendations for managing depression in adults.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) is currently updating the widely cited and internationally used 2016 CANMAT guidelines for the management of major depressive disorder (MDD). The depression guidelines 2023 update retain the familiar CANMAT methodology to evaluate clinical data and present recommendations in a Q and A format, with the updated evidence review focusing on systematic reviews and meta-analyses published since 2015. This new edition includes consensus recommendations from more than 50 Canadian experts in mood disorders representing diversity in region, seniority, expertise, and equity, as well as people with lived experience. The CANMAT depression guidelines 2023 update, to be published in the Canadian Journal of Psychiatry, adopts a person-centred approach organized along the care pathway, from screening and diagnosis to selecting an initial treatment, and providing treatment options for difficult-to-treat and persistent depressive disorders. Co-leads from four of the eight sections will present highlights of the depression guidelines 2023 update, with new and controversial recommendations. Sample questions and answers will be used to illustrate the process, including the following: What factors influence choosing specific psychotherapy, pharmacotherapy, or neurostimulation as an initial treatment? What lifestyle and self-management interventions are effective? What is the evidence to support measurement-based care, pharmacogenomic testing, and treatment discontinuation? When in the care pathway should novel therapeutics (e.g., esketamine / ketamine infusion, repetitive transcranial stimulation, psychedelics) be considered?

References:

1. Lam RW, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder. Introduction and methods. Can J Psychiatry 2016;61:506–509.
2. Cuijpers P, Noma H, Karyotaki E, et al. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry 2020;19:92–107.