Major depressive disorder (MDD) is the most prevalent depressive disorder and approximately 7% of Canadians meet its diagnostic criteria every year.
This tool is designed to support primary care providers in the treatment of adult patients (≥ 18 years) who have MDD. The tool covers treatment options, which involves psychotherapy and/or pharmacotherapy, as well as complementary and alternative options.
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To supplement the tool, we have developed appendices for clarity and assistance. Click below to download each appendix.
Appendix A: Psychotherapy options
Appendix B: Pharmacotherapy options
Appendix C and D: Adjunctive medications and special patient populations
Appendix E: Interactions for first-line and second-line antidepressants
Appendix F: Recommendations for clinical specifiers and dimensions of MDD
About the tool
The Treatment of Adult Major Depressive Disorder (MDD) Tool was developed to guide primary care providers in creating a treatment plan for their patient while keeping in mind various considerations including patient goals and preferences, clinical features, comorbid conditions and special patient populations.
The tool emphasizes a “stepped-care approach” to treatment which encourages providers to consider the least intrusive form of care before progressing to more intensive care if needed.
In order to guide difficult discussions regarding the diagnosis and treatment of MDD, we’ve included talking points throughout the tool to emphasize a stigma-free and empathetic approach.
The Treatment of Adult Major Depressive Disorder (MDD) Tool was developed using the Centre for Effective Practice’s (CEP’s) integrated knowledge translation approach. This approach ensures that providers are engaged throughout the development processes through the application of user-centered design methodology. Clinical leadership of the resource was provided by Dr. Mark Silverman. End users and clinical experts were also engaged to provide feedback.
The MDD Tool is one of several clinical tools developed as part of the Knowledge Translation in Primary Care Initiative. This multi-year initiative is a collaboration between the Centre for Effective Practice, Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative (KTinPC).
Mark Silverman has been practicing as a family doctor for over 35 years. Since 1990, over half his work has been a GP-focused psychotherapy practice.
He is a long-standing certificant member of MDPAC (Medical Psychotherapy Association of Canada) and of CMHN (Collaborative Mental Health Network).
With extensive and eclectic training and his many years of experience, he focuses most of his psychotherapy practice working with depression and anxiety.
Clinical Working Group
In addition to the clinical lead, a clinical working group of clinicians oversaw the development of this tool. Members include:
- Cindy Pritchard, RN(EC), BScN, NP-PHC
- Jose Silveira, BSC, MD, FRCPC, DIP, ABAM
- Mireille St-Jean, MD, CCFP(AM), FCFP
- Colin Wilson, MD
Conflict of interest
The clinical lead received compensation for his role.
Clinical working group members received an honorarium for their participation.
Focus group and usability participants received a small token of appreciation (e.g. gift certificate).
Thank you to everyone who supported the development of this resource!