Practice Guideline

. 2025 Jun;70(6):429-489.

doi: 10.1177/07067437241303031. Epub 2025 Feb 12.

Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals

Simone N Vigod^{1

2

3}, Benicio N Frey^{4

5}, Crystal T Clark^{1

2}, Sophie Grigoriadis^{2

6}, Lucy C Barker^{1

2}, Hilary K Brown^{1

2

3

7}, Jaime Charlebois⁸, Cindy-Lee Dennis^{2

9

10}, Nichole Fairbrother^{11

12}, Sheryl M Green^{4

5}, Nicole L Letourneau¹³, Tim F Oberlander^{14

15

16}, Verinder Sharma^{17

18}, Daisy R Singla^{2

10

19}, Donna E Stewart^{2

20}, Patricia Tomasi²¹, Brittany D Ellington¹, Cathleen Fleury¹, Lesley A Tarasoff^{1

3}, Lianne M Tomfohr-Madsen²², Deborah Da Costa^{23

24}, Serge Beaulieu²⁵, Elisa Brietzke²⁶, Sidney H Kennedy², Raymond W Lam²⁷, Roumen V Milev²⁶, Sagar V Parikh²⁸, Arun V Ravindran², Zainab Samaan²⁶, Ayal Schaffer^{2

6}, Valerie H Taylor²⁹, Smadar V Tourjman³⁰, Michael Van Ameringen⁴, Lakshmi N Yatham²⁷, Ryan J Van Lieshout^{4

5}

Affiliations

¹ Department of Psychiatry and Women's College Research and Innovation Institute, Women's College Hospital, Toronto, ON, Canada.
² Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON, Canada.
⁵ Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
⁶ Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁷ Department of Health and Society, University of Toronto, Scarborough, ON, Canada.
⁸ Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.
⁹ Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
¹⁰ Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
¹¹ Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
¹² Michael Smith Foundation for Health Research, Vancouver, BC, Canada.
¹³ Faculty of Nursing and Cumming School of Medicine, University of Calgary.
¹⁴ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
¹⁵ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
¹⁶ BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
¹⁷ Department of Psychiatry, Western University, London, ON, Canada.
¹⁸ Department of Obstetrics and Gynecology, Western University, London, ON, Canada.
¹⁹ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
²⁰ Toronto General Hospital Research Institute, Centre for Mental Health, University Health Network, Toronto, ON, Canada.
²¹ Canadian Perinatal Mental Health Collaborative, Barrie, ON, Canada.
²² Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC, Canada.
²³ Department of Medicine, McGill University, Montreal, QC, Canada.
²⁴ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
²⁵ Department of Psychiatry, McGill University, Montreal, QC, Canada.
²⁶ Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, ON, Canada.
²⁷ Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
²⁸ Department of Psychiatry, University of Michigan, Ann Arbour, MI, USA.
²⁹ Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
³⁰ Department of Psychiatry, Montreal Institute of Mental Health, Université de Montréal, Montréal, QC, Canada.

PMID: 39936923
PMCID: PMC11985483
DOI: 10.1177/07067437241303031

Practice Guideline

Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals

Simone N Vigod et al. Can J Psychiatry. 2025 Jun.

. 2025 Jun;70(6):429-489.

doi: 10.1177/07067437241303031. Epub 2025 Feb 12.

Authors

Affiliations

¹ Department of Psychiatry and Women's College Research and Innovation Institute, Women's College Hospital, Toronto, ON, Canada.
² Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON, Canada.
⁵ Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
⁶ Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁷ Department of Health and Society, University of Toronto, Scarborough, ON, Canada.
⁸ Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.
⁹ Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
¹⁰ Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
¹¹ Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
¹² Michael Smith Foundation for Health Research, Vancouver, BC, Canada.
¹³ Faculty of Nursing and Cumming School of Medicine, University of Calgary.
¹⁴ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
¹⁵ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
¹⁶ BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
¹⁷ Department of Psychiatry, Western University, London, ON, Canada.
¹⁸ Department of Obstetrics and Gynecology, Western University, London, ON, Canada.
¹⁹ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
²⁰ Toronto General Hospital Research Institute, Centre for Mental Health, University Health Network, Toronto, ON, Canada.
²¹ Canadian Perinatal Mental Health Collaborative, Barrie, ON, Canada.
²² Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC, Canada.
²³ Department of Medicine, McGill University, Montreal, QC, Canada.
²⁴ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
²⁵ Department of Psychiatry, McGill University, Montreal, QC, Canada.
²⁶ Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, ON, Canada.
²⁷ Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
²⁸ Department of Psychiatry, University of Michigan, Ann Arbour, MI, USA.
²⁹ Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
³⁰ Department of Psychiatry, Montreal Institute of Mental Health, Université de Montréal, Montréal, QC, Canada.

PMID: 39936923
PMCID: PMC11985483
DOI: 10.1177/07067437241303031

Abstract
in English, French

BackgroundThe Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders.MethodsCANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive-compulsive and post-traumatic stress disorders (January 2013-October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations.ResultsThe guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided.ConclusionsThis guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.Plain Language Summary TitleThe Canadian Network for Mood and Anxiety Treatments 2024 Guideline for Helping People with Mood, Anxiety and Related Disorders During Pregnancy and Postpartum.

Avant-propos: Le Canadian Network for Mood and Anxiety Treatments (CANMAT) publie des guides de pratique pour les troubles de l'humeur et les troubles anxieux. Le présent guide du CANMAT vise à offrir des lignes directrices complètes pour la prise en charge pendant la grossesse et le post-partum (périnatal) des troubles de l'humeur, de l'anxiété et des troubles connexes.

Méthodes: Le CANMAT a réuni un groupe de rédaction interdisciplinaire composé de cliniciens du monde universitaire, des personnes ayant un vécu expérientiel (PAVE) et 3 comités consultatifs formés de PAVE, de cliniciens spécialisés en santé périnatale et de cliniciens spécialisés en santé mentale périnatale. Nous avons recherché des revues systématiques portant sur des interventions préventives et thérapeutiques pour les troubles suivants en période périnatale : troubles dépressifs, bipolaires, anxieux, obsessionnels-compulsifs et de stress post-traumatique (janvier à octobre 2023). Nous avons privilégié les données probantes issues des revues d'essais contrôlés randomisés (ECR), à l'exception de notre évaluation de l'innocuité périnatale des médicaments, où nous avons donné la priorité aux synthèses d'études observationnelles de grande envergure et de haute qualité en raison de l'absence de données issues d'ECR. Des recherches ciblées d'études individuelles ont été effectuées lorsque les synthèses systématiques étaient limitées ou inexistantes. Les recommandations ont été organisées par lignes de traitement sur la base des critères établis par le CANMAT pour la qualité des données, ainsi qu'en nous appuyant sur le consensus du groupe de rédaction pour assurer l'équilibre de diverses considérations, notamment l'efﬁcacité, l'innocuité, la tolérabilité et la faisabilité.

Résultats: Ce guide comporte 10 sections cliniques sous forme de questions-réponses qui suivent le parcours de soins du patient : dépistage; organisation et prestation des soins; approches non pharmacologiques (psychosociales, psychologiques ou liées au mode de vie), pharmacothérapies, neuromodulation, interventions complémentaires et alternatives; situations cliniques à risque élevé; et santé mentale du père ou de la partenaire. Le guide tient compte des principes d'équité, de diversité et d'inclusion.

Conclusions: Les recommandations détaillées de ce guide, fondées sur des données probantes fournissent aux cliniciens des renseignements pertinents pour promouvoir la prestation de soins de santé mentale qui sont sûrs et efficaces en période périnatale. Nous espérons que cette ligne directrice s'avérera un outil précieux pour les cliniciens du Canada et du monde entier afin d'optimiser les résultats cliniques dans le domaine de la santé mentale périnatale.

Keywords: anxiety disorder; bipolar disorder; clinical practice guidelines; depression; mood disorder; obsessive–compulsive disorder; perinatal; post-traumatic stress disorder; postpartum depression; postpartum period; postpartum psychosis; pregnancy.

Plain language summary

The Canadian Network for Mood and Anxiety Treatments publishes guidelines for healthcare providers, to aid them in staying up-to-date with the latest and best evidence around treatments for mood and anxiety problems. This is the first time that CANMAT is publishing a guideline that focuses specifically on mental health during pregnancy and postpartum (the perinatal period). The guideline primarily focuses on treatment recommendations, including both medication and non-medication options. It explains when and how to use these treatments to make sure they are as effective as possible. Importantly, the guideline was developed in close collaboration with a diverse group of people, including people who have experience with mood and anxiety problems during the perinatal period, as well as clinicians from various fields of expertise. In creating this guideline, we reviewed scientific papers that combine results from multiple studies and considered the quality of the research when making recommendations. We also aimed to include equity, diversity and inclusion in our considerations. We hope that this clinical guideline will be a helpful tool for healthcare providers to improve care for people experiencing mental health issues during pregnancy and after childbirth.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declare the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Simone N. Vigod declares royalties from UpToDate Inc. for the authorship of materials related to depression and pregnancy and a leadership or fiduciary role in other board, society, committee or advocacy group for CANMAT and Marcé of North America. Benicio N. Frey declares a leadership role in the CANMAT board. Lucy C. Barker declares a leadership or fiduciary role in other board, society, committee or advocacy group for Marce of North America. Serge Beaulieu declares grants or contracts from Lundbeck-Otsuka Consortium and Diamentis, consulting fees from Otsuka, Lundbeck, Idorsia, Abbvie, Eisai and Janssen, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Otsuka, Abbvie and Janssen, participation on a data safety monitoring board or advisory board for the AIFRED trial, and a leadership or fiduciary role in other board, society, committee or advocacy group for CANMAT and myRelief.ca. Hilary K. Brown has nothing to disclose. Elisa Brietzke declares a leadership or fiduciary role in other board, society, committee or advocacy group for CANMAT. Jaime Charlebois has nothing to disclose. Crystal T. Clark declares personal fees for consulting from Seven Starling, Biogen and Six Sense Strategy, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Deloitte, support for attending meeting and/or travel from the American Board of Psychiatry and Neurology, and a leadership or fiduciary role in other board, society, committee or advocacy group for the Marcé of North American Board of Directors and Marcé International Board of Directors. Cindy-Lee Dennis has nothing to disclose. Deborah Da Costa has nothing to disclose. Brittany D. Ellington has nothing to disclose. Nichole Fairbrother declares grants or contracts from the Canadian Institutes of Health Research (CIHR) and Women's Health Research Institute, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events for Austin Anxiety and OCD Specialists, support for attending meetings and/or travel from the House of Commons Standing Committee of Health, Society for Reproductive and Infant Psychology and Canadian National Perinatal Research Meeting conferences, participation on a data safety monitoring board or advisory board for Maternal OCD, and a leadership or fiduciary role in other board, society, committee or advocacy group for UBC Women's Health Research Cluster, BC Ministry of Health, Women's Health Research Institute and the Canadian Perinatal Mental Health Collaborative. Cathleen Fleury has nothing to disclose. Sheryl M. Green declares royalties from a book authored on perinatal mental health. Sophie Grigoriadis declares grants or contracts from the Lotte & John Hecht Memorial Foundation, royalties or licenses from UptoDate for depression in pregnancy, Canadian Pharmacists Association and Norton for chapters on depression, consulting fees for the Canadian Medical Protective Association, Goodmans LLP and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from LifeSpeak. Sidney H. Kennedy declares a leadership or fiduciary role in other board, society, committee or advocacy group for CB Solutions and CANMAT. Raymond W. Lam declares grants or contracts from Brain Canada, CANMAT, Canadian Institutes of Health Research, VGH-UBCH Foundation, BC Leading Edge Endowment Fund, MITACS, Ontario Brain Institute, Michael Smith Foundation for Health Research, Healthy Minds Canada, Unity Health, Vancouver Coastal Health Research Institute and Grand Challenges Canada, consulting fees for Neurotorium, Otsuka, Bausch and Abbvie, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events for Otsuka, Carnot, Shanghai Mental Health Center and Canadian Medical Protective Association, support for attending meetings and/or travel for Asia-Pacific Economic Cooperation, Neurotorium and GenomeBC and a leadership or fiduciary role in other board, society, committee or advocacy group for Genome BC, CB Solutions and CANMAT. Nicole L. Letourneau has nothing to disclose. Roumen V. Milev declares grants or contracts from CAN-BIND, CIHR, Janssen, OBl, Lundbeck, Lallemand HS and Nubiyota, consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Eisai, Neonmind, Janssen and Lallamand, participation on data safety monitoring board or advisory board for Janssen, Lundbeck, Abbvie and Biogen and a leadership or fiduciary role in other board, society, committee or advocacy group for CANMAT and CANBIND Solutions. Tim F. Oberlander has nothing to disclose. Sagar V. Parikh declares grants or contracts from Sage Pharma, Merck Pharma, Jenssen Pharma and Aifred, personal fees for consulting from Sage Pharma, Janssen, Mensante and Myriad/Assurex, personal fees for lectures from Otsuka and Medscape CME company, personal fees for participation on a data safety monitoring board or advisory board from Boehringer Ingelheim and Otsuka, a leadership or fiduciary role in other board, society, committee or advocacy group for National Network of Depression Centers and CANMAT, and holds stock or stock options for Mensante. Arun V. Ravindran declares a leadership or fiduciary role in other board, society, committee or advocacy group for CANMAT. Zainab Samaan declares grants or contracts from CIHR, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Ontario Psychiatry Association and a leadership or fiduciary role in other board, society, committee or advocacy group for CANMAT. Ayal Schaffer declares payment or honoraria for lectures, speakers bureaus, manuscript writing or educational events from AbbVie and Otsuka, and a leadership or fiduciary role in other board, society, committee or advocacy group for the International Society for Bipolar Disorders and CANMAT. Verinder Sharma declares grants or contracts from AMOSO and Pooler Charitable Fund and royalties or licenses from Otsuka-Lundbeck Alliance. Daisy R. Singla has nothing to disclose. Donna E. Stewart declares royalties or licenses from UpToDate for authorship of materials related to depression and pregnancy, payment for expert testimony from CMPA, and support for attending meetings and/or travel from World Psychiatric Association. Valerie H. Taylor declares leadership or fiduciary role in other board, society, committee or advocacy group for CANMAT. Lesley A. Tarasoff has nothing to disclose. Patricia Tomasi has nothing to disclose. Lianne M. Tomfohr-Madsen declares no financial disclosures as co-founder of Tomfohr & Roos eHealth Consulting. Smadar V. Tourjman declares grants or contracts from DiaMentis and AbbVie, personal fees for lectures, presentations, speakers bureaus, manuscript writing or educational events and participation on a data safety monitoring board or advisory board from AbbVie, Eisai, Idorsia, Elvium, Lundbeck, Otsuka, Sunovion, Janssen, Takeda and Pfizer, and a leadership or fiduciary role in other board, society, committee or advocacy group for CANMAT and CADDRA. Michael Van Ameringen declares grants or contracts from Michael G. DeGroote Centre for Medicinal Cannabis Research, Elvium, Biohaven, Clairvoyant and Otsuka, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Lundbeck, Pfizer and Takeda, participation on data safety monitoring board or advisory board for AbbVie, Lundbeck, Otsuka, Bausch Health, Biogen, Biron and Boehringer Ingelheim, and a leadership or fiduciary role in other board, society, committee or advocacy group for the International College of Obsessive–Compulsive Spectrum Disorders, Obsessive–Compulsive Research Network of the European College of Neuropsychopharmacology and CANMAT. Ryan J. Van Lieshout has nothing to disclose. Lakshmi N. Yatham declares grants or contracts from Abbvie and Sumitomo, consulting fees from Allergan, Alkermes, Sumitomo, Intracellular Therapies, Lundbeck, Merck, Xenon, Sunovion and LivNova, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Sumitomo Pharma and Sanofi, participation on a data safety monitoring board or advisory board for Alkermes, a leadership or fiduciary role in other board, society, committee or advocacy group for the World Federation of Societies of Biological Psychiatry, Neurotorium, International Bipolar Foundation, Depression and Bipolar Support Alliance and CANMAT, and receipt of equipment, materials, drugs, medical writing, gifts or other services from PBG Biopharma.

Figures

**Figure 1.**
How PMAD illness severity can guide initial treatment selection. For a given illness severity, the lowest checkmarked intervention type is typically needed, but interventions in higher rows may also be implemented to complement the effect of the main intervention.

See this image and copyright information in PMC

References

1. Statistics Canada. Maternal Mental Health in Canada, 2018/2019 (Released: 24 June 2019). Accessed 14 March 2024. https://www150.statcan.gc.ca/n1/daily-quotidien/190624/dq190624b-eng.htm
1. Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The prevalence of anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry. 2019;80(4):18r12527. doi: 10.4088/JCP.18r12527 - DOI - PMC - PubMed
1. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384(9956):1775-1788. doi: 10.1016/S0140-6736(14)61276-9 - DOI - PubMed
1. Stein A, Pearson RM, Goodman SH, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800-1819. doi: 10.1016/S0140-6736(14)61277-0 - DOI - PubMed
1. Institute of Medicine (US) Committee. Standards for developing trustworthy clinical practice guidelines. In Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, editors. Clinical practice guidelines we can trust. USA: National Academies Press; 2011. - PubMed

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Abstract
in English, French

Plain language summary

Conflict of interest statement

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References

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MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Abstract in English, French

Plain language summary

Conflict of interest statement

Figures

References

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Full Text Sources

Medical

Abstract
in English, French