Should antidepressants be used for major depressive disorder?

BMJ Evid Based Med. 2020 Aug;25(4):130. doi: 10.1136/bmjebm-2019-111238. Epub 2019 Sep 25.


Background: Major depressive disorder is estimated by the WHO to affect more than 300 million people globally, making depression the leading cause of disability worldwide. Antidepressants are commonly used to treat depression.

Objective: The study aimed to provide an update on the evidence on the effects of antidepressants compared with placebo. Should antidepressants be used for adults with major depressive disorder?

Study selection: We searched the Cochrane Library, BMJ Best Practice and PubMed up to June 2019 with the search terms 'depression' and 'antidepressants' targeting reviews published in English since 1990.

Findings: Several reviews have assessed the effects of antidepressants compared with placebo for depression. Generally, all the previous reviews show that antidepressants seem to have statistically significant effects on depressive symptoms, but the size of the effect has questionable importance to most patients. Antidepressants seem to have minimal beneficial effects on depressive symptoms and increase the risk of both serious and non-serious adverse events.

Conclusions: The benefits of antidepressants seem to be minimal and possibly without any importance to the average patient with major depressive disorder. Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antidepressive Agents / therapeutic use*
  • Depressive Disorder, Major / drug therapy*
  • Humans
  • Treatment Outcome


  • Antidepressive Agents