Kennedy SH, Lam RW, McIntyre RS, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. pharmacological treatments. Can J Psychiatry. 2016;61(9):540-560. (Original DOI: 10.1177/0706743716659417)
MacQueen GM, Frey BN, Ismail Z, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 6. youth, women, and the elderly. Can J Psychiatry. 2016;61(9):588-603. (Original DOI: 10.1177/0706743716659276)
On page 543, in Table 3, the mechanism for the antidepressants Mianserin and Mirtazapine should be labeled “α2-Adrenergic antagonist,” rather than “α2-Adrenergic agonist.”
On page 546, desvenlafaxine was not included in the list of antidepressants with a lower risk of sexual side effects. The sentence should read: “In studies that used standardized rating scales or interviews, which are more likely to reliably detect sexual side effects, agomelatine, bupropion, desvenlafaxine, mirtazapine, vilazodone, and vortioxetine demonstrated lower risk.”
On page 547, in Table 7, the column labeled “Male Sexual Dysfunction” should be omitted from the table.
On page 551, in Figure 2, the box labeled “Switch to antidepressant with superior efficacy (Table 6)” should read “Switch to another first-line antidepressant, preferably with superior efficacy (Table 6).”
Table 6.
Algorithmic Pharmacological Treatment of Late-life Depression (see text).
| Treatment | Level of Evidence* | |
|---|---|---|
| First Step (use one or more agents in sequence) | Duloxetine. | Level 1 |
| Mirtazapine, sertraline, venlafaxine, vortioxetine. | Level 2 | |
| Citalopram, desvenlafaxine, escitalopram. | Level 3/4 | |
| Second Step (if multiple first-step treatments are not effective or not indicated) | Switch to | |
| Nortriptyline. | Level 1 | |
| Fluoxetine, moclobemide, paroxetine, phenelzine, quetiapine, trazodone. | Level 2 | |
| Bupropion. | Level 3 | |
| Or combine with | ||
| Aripiprazole. | Level 1 | |
| Methylphenidate. | Level 2 | |
| Lithium. | Level 3 | |
| Third Step (if multiple first- and second-step treatments are not effective or not indicated) | Switch to | |
| Amitriptyline, imipramine. | Level 2 | |
| or | ||
| Combine SSRI or SNRI with bupropion. | Level 3 |
*Based on evidence in studies of late-life depression samples.
SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin-norepinephrine reuptake inhibitor.
On page 598, Table 6, should be revised as follows: