Abstract：
BACKGROUND: The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults.
METHODS: CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process.
RESULTS: The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted.
CONCLUSIONS: The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.
METHODS: CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process.
RESULTS: The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted.
CONCLUSIONS: The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.
摘要：
背景：加拿大情绪和焦虑治疗网络（CANMAT）最近于2016年发布了重度抑郁症（MDD）的临床指南。由于该领域的进展，需要更新以纳入新的证据,并为成人MDD的评估和管理提供新的和修订的建议.
方法：CANMAT召集了一个由学术临床医生和患者伙伴组成的指南编辑小组。进行了系统的文献综述，重点关注自2016年指南以来发表的系统评价和荟萃分析.建议是按治疗方案组织的，由CANMAT定义的证据水平提供信息，并辅以临床支持（包括关于安全性的专家共识，耐受性,和可行性)。草稿根据患者合作伙伴的审查进行了修订，专家同行评审，和明确的专家共识过程。
结果：更新的指南包括八个主要主题，以问答的形式，绘制了从评估到选择循证治疗的患者护理旅程，预防复发，以及应对不足的策略。该指南采用个性化的护理方法，强调反映价值观的共同决策，preferences,以及MDD患者的治疗史。表格提供了新的和更新的心理建议，药理学,生活方式,补充和替代医学，数字健康,和神经调节治疗。强调了证据的警告和局限性。
结论：CANMAT2023更新指南为MDD的管理提供了有证据的建议，以临床医生友好的格式。这些更新的指导方针强调了协作，个性化，和系统的管理方法，这将有助于优化成人MDD的结果。
方法：CANMAT召集了一个由学术临床医生和患者伙伴组成的指南编辑小组。进行了系统的文献综述，重点关注自2016年指南以来发表的系统评价和荟萃分析.建议是按治疗方案组织的，由CANMAT定义的证据水平提供信息，并辅以临床支持（包括关于安全性的专家共识，耐受性,和可行性)。草稿根据患者合作伙伴的审查进行了修订，专家同行评审，和明确的专家共识过程。
结果：更新的指南包括八个主要主题，以问答的形式，绘制了从评估到选择循证治疗的患者护理旅程，预防复发，以及应对不足的策略。该指南采用个性化的护理方法，强调反映价值观的共同决策，preferences,以及MDD患者的治疗史。表格提供了新的和更新的心理建议，药理学,生活方式,补充和替代医学，数字健康,和神经调节治疗。强调了证据的警告和局限性。
结论：CANMAT2023更新指南为MDD的管理提供了有证据的建议，以临床医生友好的格式。这些更新的指导方针强调了协作，个性化，和系统的管理方法，这将有助于优化成人MDD的结果。
