Depression is the most common and prevalent mental disorder today, affecting an estimated 1 in 4 Canadians at some point in their lifetime. Physical activity is recommended as a primary treatment for mild to moderate depression and a secondary treatment for moderate to severe depression.
Full Answer
Are there evidence-based guidelines for the treatment of depression in Canada?
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 thetreatmentofdepressivedisorders.A revisionoftheseguidelineswasundertakenby CANMAT in 2008–2009 to reflect advances in the field.
Are there any CANMAT treatment guidelines for bipolar disorder?
CANMAT Depression Treatment Guidelines for Clinicians. The Canadian Network for Mood and Anxiety Treatments (CANMAT) is a network of academic and clinical leaders in depressive, bipolar and anxiety disorders. CANMAT produces resources, including treatment guidelines, for clinicians, patients and the public to improve clinical care.
What are the treatment options for major depressive disorder in adults?
Major Depressive Disorder in Adults - Diagnosis and Management 1 Lifestyle – Self-Care 19. Recommend lifestyle management for all patients with depression. 2 Self-Management 20. Recommend self-management for all patients with depression. 3 Psychotherapy. Recommend psychotherapy in the acute phase of mild to moderate depression and/or...
What are the phases of depression treatment under CANMAT?
The CANMAT guidelines identify 2 phases of depression treatment: an acute phase (getting to symptomatic remission) and a maintenance phase (preventing relapse and recurrence) (see Section 13).
What is the appropriate treatment for depression?
Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.
What are the three treatments for depression?
There are many types of therapy available. Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.
Are generally considered 1st line treatment for depression?
Main Points. Consider sertraline and escitalopram as first-line agents for initial treatment of major depression in adults.
What are possible treatments for patients with major depression?
How is depression treated?Medicine. Antidepressants work by affecting the brain chemicals. ... Therapy. This is most often cognitive behavioral and/or interpersonal therapy. ... Electroconvulsive therapy (ECT). This treatment may be used to treat severe, life-threatening depression that has not responded to medicines.
How can depression be treated and prevented?
You can help prevent depression by getting enough sleep, eating a healthy diet and practicing regular self-care activities such as exercise, meditation and yoga. If you've had depression before, you may be more likely to experience it again. If you have depression symptoms, get help.
What are the 3 levels of depression?
Symptoms of depression interfere with all areas of a person's life, including work and social relationships. Depression can be described as mild, moderate or severe; melancholic or psychotic (see below).
What is second line treatment for depression?
Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors are considered second line due to tolerability and safety issues. Other adjunctive medications include atypical antipsychotics, lithium, adding a second antidepressant, buspirone, and thyroid hormone (T3) among others.
What is the best first-line antidepressant?
The investigators recommend sertraline as the best choice for an initial antidepressant because it is available in generic form and is therefore lower in cost. They further recommend that sertraline, instead of fluoxetine or placebo, be the new standard against which other antidepressants are compared.
What is the first medication prescribed for depression?
Consider sertraline and escitalopram as first-line agents for initial treatment of major depression in adults. The least tolerated antidepressants in this study were bupropion, fluoxetine, paroxetine, and duloxetine.
Which form of therapy is most effective for major depression?
Studies have shown that cognitive therapy is an effective treatment for depression and is comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy. The combination of cognitive therapy and antidepressants has been shown to effectively manage severe or chronic depression.
Can depression be treated successfully?
Taking an antidepressant or going to psychological counseling (psychotherapy) eases depression symptoms for most people. But with treatment-resistant depression, standard treatments aren't enough. They may not help much at all, or your symptoms may improve, only to keep coming back.
What is shock treatment for depression?
Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments. ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia.
How to prevent relapses in depression?
Self-management programs may be helpful to prevent relapses. 3. Psychotherapy. Recommend psychotherapy in the acute phase of mild to moderate depression and/or maintenance phase of depression treatment to prevent relapse.
What is self management for depression?
Recommend self-management for all patients with depression. When appropriate, use education and self-management resources (see Associated Document: Resource Guide: Information Sources for Physicians [PDF, 145KB] ), including available community resources and self-help agencies. Self-management programs may be helpful to prevent relapses.
How long do you have to take antidepressants after remission?
Several non-pharmacological and pharmacological interventions are available in the short, medium and long term. Antidepressants are continued for at least 6 months after remission.
How many Canadians have MDD?
Approximately 11% of Canadians meet criteria for MDD at some point in their lives and approximately 4% of Canadians suffer from MDD within any given year. 1 About 2% of people with depression commit suicide, and 50% of these individuals will have been in contact with their general practitioner in the month preceding the suicide. 2
What is PHQ-9?
The PHQ-9 is a patient administered questionnaire that aids in the diagnosis and assesses the severity (e.g. , mild, moderate, severe) of depression. 6-9. Consider: Differential diagnosis, particularly screening for Bipolar I and II; Past history of depression and its treatment;
Where is the Antidepressant Skills Workbook?
Antidepressant Skills Workbook – a self-help workbook developed at the Centre for Applied Research in Mental Health & Addiction at Simon Fraser University. Also available in Chinese and Punjabi.
What is first line antidepressant?
“First-line” antidepressant treatment represents a balance of ecacy, tolerability and expert consideration per the Canadian Network for Mood and Anxiety Treatments (CANMAT) recommendations. Other pharmacotherapies are reserved for situations where first-line antidepressants are not indicated or cannot be used, or when first-line treatments have not worked.
Recommendations and Topics
Scope
Key Recommendations
- Screen for MDD with ‘two quick question’ method.
- Use the Patient Health Questionnaire-9 (PHQ-9) to aid in diagnosing and monitoring patients.
- Assess suicide risk in all depressed patients.
- Several non-pharmacological and pharmacological interventions are available in the short, medium and long term.
Epidemiology
- Approximately 11% of Canadians meet criteria for MDD at some point in their lives and approximately 4% of Canadians suffer from MDD within any given year.1 About 2% of people with depression commit suicide, and 50% of these individuals will have been in contact with their general practitioner in the month preceding the suicide.2 TOP
Diagnosis
- Screening
Screen patients who present with symptoms for MDD.3 Note that some patients present with somatic symptoms. Use the 'two quick question' screening method.4 In the past month: 1. Have you lost interest or pleasure in things you usually like to do? 2. Have you felt sad, low, down, dep… - Assessment
The detailed assessment includes: 1. Clinical interview to determine if the patient meets the Diagnostic and Statistical Manual of Mental Disorders (5th edition)5 criteria to diagnose MDD by using S2IGECAPS and focusing on functional status. 1. Review PHQ-9 score and responses.* Th…
Management
- Treatment10
The goal of acute treatment is remission of symptoms (e.g., PHQ-9 score < 5) and to restore psychosocial functioning. The goal of maintenance treatment is to return to full social and occupational function and to prevent recurrence. 1. Establish treatment decisions on the severit… - 1. Lifestyle – Self-Care19
Recommend lifestyle management for all patients with depression. Discuss the importance of a healthy lifestyle such as: 1. Regular exercise 2. Healthy regular meals 3. Sleep hygiene 4. Avoiding substance use 5. Adequate housing 6. Stress management strategies 7. Engaging in at least on…
Resources
- References
1. Minister of Public Works and Government Services Canada. The human face of mental health and mental illness in Canada [Internet]. Ottawa: Government of Canada; 2006 [cited 2013 Jun 25]. 2. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers befo… - Appendices
1. Appendix A: Medications that Mimic Mood Disorders (PDF, 100KB) 2. Appendix B: First-Line Psychotherapies for Treatment of Depression (PDF, 99KB) 3. Appendix C: First-Line Antidepressants (PDF, 138KB) 4. Appendix D: Switching Antidepressants (PDF, 110KB) 5. Appen…