Almost 12.6 per cent of Canadian adults report experiencing symptoms related to a mood disorder, including depression and bipolar disorder, at some point during their lifetime.
With the prevalent stigma toward mood disorders, patients may not fully disclose their symptoms to physicians, making diagnostic accuracy and effective medical treatment challenging. Coupled with high rates of burnout among mental health professionals preventing them from performing their duties effectively, health care professionals need support more than ever.
Medical professionals rely on guides like the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines. It’s one of the most widely used sets of clinical guidelines for depression worldwide and was developed by a group of over 40 researchers and patient partners from across Canada
The CANMAT guidelines were updated in 2023 from the previous version in 2016 to include more supported scientific evidence and revised recommendations for health care professionals in addressing major depressive disorder (MDD) in adults.
Updating the guidelines
CANMAT, an organization of academic and clinical experts in mood disorders, was established in 1995 to improve clinical care for people experiencing mood and anxiety disorders by providing accurate scientific information and accessible treatment guidelines for patients and their families.
“One of our main objectives is knowledge translation,” said Dr. Raymond Lam, a UBC professor of psychiatry and a co-lead author of the CANMAT updates. “These clinical guidelines that we develop really are a series of recommendations to help doctors and other mental health professionals better treat their patients.”
The 2023 CANMAT guidelines are the fourth reiteration since the development of the first version over 20 years ago, with new versions being released every 7 or 8 years.
The nationwide research group assessed all available evidence in the scientific literature to provide treatment recommendations, with the results evaluated and approved by experts in a rigorous peer-review process. Recommendations were organized into defined levels of evidence supported by clinical consensus on feasibility, safety and tolerability to ensure physicians are informed with the most up-to-date information.
Incorporating patient-centred care
One of the most prominent updates in the 2023 CANMAT guidelines is emphasizing patient-centred care, which prioritizes educating patients and involving them in decision-making processes. The guidelines highlight psychoeducation, incorporating knowledge and information about symptoms, treatment options and coping strategies for depression among patients.
“We focus on the importance of shared decision-making, where patients have to understand their illness and understand what treatments are available so that they can make a joint decision with their mental health professional [to select] treatments,” said Lam.
Patient-centred approaches have been key in the development of the CANMAT guidelines since their inception. Patients with experiences of MDD, who Lam regarded as “an integral part” of the development, participated in the author group by developing questions and reviewing recommendations presented by the researchers.
New psychotherapies and antidepressants
Other updates included recommendations for new psychotherapies and antidepressants. While the main three therapies — cognitive behaviour therapy, interpersonal psychotherapy and behavioural activation — remained from the 2016 guidelines, new therapies were proposed in the updated version.
For example,transdiagnostic psychological treatment, a therapy that seeks to tackle shared commonalities between disorders, was introduced and found to be particularly beneficial in individuals with multiple mood and anxiety disorders.
The new guidelines also incorporated medications to enhance the effectiveness of antidepressants, which Lam termed “adjunctive treatment.” One such medication is ketamine, an anesthetic that can be effective in combatting depression if prescribed in low doses via intravenous administration.
Embracing accessibility
Although highly informative, reading the 45-page-long CANMAT guidelines can be time-consuming for busy physicians.
“It’s very difficult to change clinician behaviour, whether you’re a doctor, psychologist or any other mental health professional,” said Lam, “People tend to do what they’ve learned and what they’ve always done.”
To encourage clinicians to consult the guidelines, Lam and his colleagues published a pocket guide to summarize key points. They also released a free patient guide to ensure patient understanding of the treatments, with plans to update the guide to reflect the 2023 CANMAT guidelines very soon.
“Whether you're a doctor, psychologist or any other mental health professional… People tend to do what they've learned and what they've always done,” said Lam.
To encourage clinicians to consult the guidelines, Lam and his colleagues published a pocket guide to summarize key points. They also released a free patient guide to ensure patient understanding of the treatments, with plans to update the guide to reflect the 2023 CANMAT guidelines very soon.
“The science moves on.”
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