Depression selector
Choose the guideline lens (CANMAT / NICE / APA), then the patient’s predominant symptoms, comorbidities and tolerability priorities — get a first-line antidepressant matched to that profile, with the safety flags (pregnancy, cardiac/QT, tamoxifen, seizure) that gate the choice.
Guideline lens
Predominant symptoms
Match the agent's side-effect profile to the target symptoms
Comorbidities
Tolerability priorities
Safety flags
CANMAT framing
Choose a first-line agent matched to the symptom/side-effect profile; use measurement-based care (e.g. PHQ-9) and review at 2–4 weeks.
Notes
- • A prior good response (personal or first-degree relative) to a specific agent is one of the strongest predictors — let it override generic ranking. After an adequate trial: switch if minimal response, augment (e.g. aripiprazole/lithium) if partial (CANMAT).
Suggested drug classesPer CANMAT 2023.
Select the predominant symptoms and any comorbidities to begin.
e.g. fatigue → bupropion; comorbid pain → duloxetine; insomnia → mirtazapine; sexual-side-effect concern → bupropion/mirtazapine/vortioxetine; pregnancy → sertraline (paroxetine ruled out).
Guidelines
- 2023CANMAT — CANMAT 2023 Guidelines for the Management of MDD in Adults (broadest first-line set; measurement-based care) link
- 2022NICE — NG222 — Depression in adults (stepped/matched care; antidepressants not routine first-line for less-severe) link
- 2010APA — APA Practice Guideline for MDD, 3rd ed. (no newer APA psychiatric MDD guideline exists) link
References
- [1]Lam RW, Kennedy SH, et al. CANMAT 2023 Guidelines for the Management of Major Depressive Disorder in Adults. Can J Psychiatry 2024;69(9):641 (expanded first-line set; measurement-based care). link
- [2]NICE NG222 — Depression in adults: treatment and management, 2022 (stepped/matched care). link
- [3]APA Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 3rd ed., 2010. link