Clinical Guidelines for the Treatment of Depressive Disorders IV. Medications and Other Biological Treatments

Background: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders.

Methods: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, “Medications and Other Biological Treatments,” is 1 of 7 articles that were drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review.

Results: Evidence-based recommendations are presented for 1) choosing an antidepressant, based on efficacy, tolerability, and safety; 2) the optimal use of antidepressants, including augmentation, combination, and switching strategies; 3) maintenance treatment; and 4) electroconvulsive therapy (ECT), light therapy, and additional somatic treatments. Evidence from metaanalv-ses is presented first, followed by conclusions from randomized controlled trials (RCTs) and, if appropriate, open-label data.

Conclusions: There is significant evidence to support the role of selective serotonin reuptake inhibitors (SSRls), novel agents, and classic agents in the treatment of major depressive disorder (MDD). There is also evidence to support the use of somatic treatments, including ECT and light therapy, for some patients with MDD. There is limited evidence for the use of specific medications to treat subtypes of MDD. There is emerging evidence to support augmentation and combination strategies for patients previously nonresponsive to medication.