Ravindran Arun V, Balneaves Lynda G, Faulkner Guy, Ortiz Abigail, McIntosh Diane, Morehouse Rachel L, Ravindran Lakshmi, Yatham Lakshmi N, Kennedy Sidney H, Lam Raymond W, MacQueen Glenda M, Milev Roumen V, Parikh Sagar V
Department of Psychiatry, University of Toronto, Toronto, Ontario
Department of Psychiatry, University of Toronto, Toronto, Ontario.
Can J Psychiatry. 2016 Sep;61(9):576-87. doi: 10.1177/0706743716660290. 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. "Complementary and Alternative Medicine Treatments" is the fifth of six sections of the 2016 guidelines.
Evidence-informed responses were developed for 12 questions for 2 broad categories of complementary and alternative medicine (CAM) interventions: 1) physical and meditative treatments (light therapy, sleep deprivation, exercise, yoga, and acupuncture) and 2) natural health products (St. John's wort, omega-3 fatty acids; S-adenosyl-L-methionine [SAM-e], dehydroepiandrosterone, folate, Crocus sativus, and others). Recommendations were based on available data on efficacy, tolerability, and safety.
For MDD of mild to moderate severity, exercise, light therapy, St. John's wort, omega-3 fatty acids, SAM-e, and yoga are recommended as first- or second-line treatments. Adjunctive exercise and adjunctive St. John's wort are second-line recommendations for moderate to severe MDD. Other physical treatments and natural health products have less evidence but may be considered as third-line treatments. CAM treatments are generally well tolerated. Caveats include methodological limitations of studies and paucity of data on long-term outcomes and drug interactions.
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，重点关注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。“补充和替代医学治疗”是2016年指南六个部分中的第五部分。
针对补充和替代医学（CAM）干预的两大类12个问题制定了基于证据的回答：1）身体和冥想治疗（光疗法、睡眠剥夺、运动、瑜伽和针灸）以及2）天然健康产品（圣约翰草、ω-3脂肪酸、S-腺苷-L-甲硫氨酸[SAM-e]、脱氢表雄酮、叶酸、藏红花等）。建议基于关于疗效、耐受性和安全性的现有数据。
对于轻度至中度严重程度的MDD，推荐运动、光疗法、圣约翰草、ω-3脂肪酸、SAM-e和瑜伽作为一线或二线治疗。辅助运动和辅助圣约翰草是中度至重度MDD的二线推荐。其他身体治疗和天然健康产品的证据较少，但可考虑作为三线治疗。CAM治疗一般耐受性良好。需要注意的是研究存在方法学局限性，以及长期结局和药物相互作用的数据匮乏。
