Brazilian Psychiatric Association Guidelines for pharmacological treatment of Major Depressive Disorder: An overview of systematic reviews and meta-analyses.
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) May 1, 2026 Marcelo Pinheiro Machado Adelino, Julia Diniz Grossi, Marcel Vella Nunes et al.
An overview of systematic reviews and meta-analyses on pharmacological treatments for major depressive disorder (MDD) was conducted to update Brazilian clinical guidelines. Forty studies were included. For acute treatment, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, mirtazapine, and vortioxetine showed consistent evidence across efficacy and tolerability. For adjunctive treatment, atypical antipsychotics had the highest certainty of evidence, with short-term support for benzodiazepines. In treatment-resistant depression, ketamine, esketamine, and atypical antipsychotic augmentation showed moderate certainty for response outcomes. In the maintenance phase, SSRIs and SNRIs had the most consistent evidence for relapse prevention and acceptability. The findings support a hierarchy of pharmacological strategies across MDD stages, but implementation should consider local healthcare context and resource availability.