Brazilian Psychiatric Association Guidelines for pharmacological treatment of Major Depressive Disorder: An overview of systematic reviews and meta-analyses.

OBJECTIVE: To synthesize evidence on pharmacological treatments for major depressive disorder (MDD) to inform updated Brazilian clinical guidelines. METHODS: This overview included systematic reviews and meta-analyses published in the last 10 years, identified through MEDLINE, Cochrane Library, and SciELO. Eligible studies involved adults with MDD receiving pharmacological interventions. Risk of bias was assessed using ROBIS, methodological quality using AMSTAR 2, and certainty of evidence using the GRADE approach. RESULTS: Forty studies were included. In acute treatment, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, mirtazapine, and vortioxetine showed consistent evidence across efficacy and tolerability outcomes. For adjunctive treatment, atypical antipsychotics demonstrated 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 were associated with the most consistent evidence for relapse prevention and acceptability. CONCLUSION: These findings support a hierarchy of pharmacological strategies across different stages of MDD. Although consistent with international guidelines, their implementation should consider local healthcare context and resource availability.