MacQueen Glenda M, Frey Benicio N, Ismail Zahinoor, Jaworska Natalia, Steiner Meir, Lieshout Ryan J Van, Kennedy Sidney H, Lam Raymond W, Milev Roumen V, Parikh Sagar V, Ravindran Arun V
Department of Psychiatry, University of Calgary, Calgary, Alberta
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.
Can J Psychiatry. 2016 Sep;61(9):588-603. doi: 10.1177/0706743716659276. Epub 2016 Aug 2.
The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals.
Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section on "Special Populations" is the sixth of six guidelines articles.
Recent studies inform the treatment of MDD in children and adolescents, pregnant and breastfeeding women, women in perimenopause or menopause, and the elderly. Evidence for efficacy of treatments in these populations is more limited than for the general adult population, however, and risks of treatment in these groups are often poorly studied and reported.
Despite the limited evidence base, extant data and clinical experience suggest that each of these special populations can benefit from the systematic application of treatment guidelines for treatment of MDD.
加拿大情绪与焦虑治疗网络(CANMAT)通过更新证据和建议对2009年指南进行了修订。2016年指南的范围仍然是成人重度抑郁症(MDD)的管理,目标受众是精神科医生和其他心理健康专业人员。
采用问答形式,我们进行了系统的文献检索,重点是系统评价和荟萃分析。证据根据CANMAT定义的证据水平标准进行分级。治疗方案的建议基于证据质量和临床专家共识。“特殊人群”这一部分是六篇指南文章中的第六篇。
近期研究为儿童、青少年、孕妇和哺乳期妇女、围绝经期或绝经后妇女以及老年人的MDD治疗提供了信息。然而,这些人群中治疗效果的证据比一般成年人群更有限,而且这些群体中治疗风险的研究和报告往往不足。
尽管证据基础有限,但现有数据和临床经验表明,这些特殊人群中的每一类都能从系统应用MDD治疗指南中获益。