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Long-term antidepressant use and outcomes in adults: A systematic review
Wallis K, McDonald S, King DB, Liu C, van Leeuwen E, Moncrieff J, Horowitz M, Waller M et al.. PsyArXiv, 2026-08-18
Topic: Drug trials: efficacy and safety
Forty-eight studies, mostly of weak- or moderate-quality, met inclusion criteria. Four weak-quality studies investigated mental health symptoms, including three RCT-extension studies investigating depressive symptoms with inconsistent findings. Forty-four observational studies examined eight other outcome domains: diabetes, weight and glucose homeostasis; dementia and cognitive performance; cancer; eye conditions; self-reported emotional, interpersonal and biological effects; functional limitation, falls and fracture in older people; Parkinson’s disease and levodopa-induced dyskinesia in people with Parkinson’s disease; and all-cause mortality and suicide. There is evidence that long-term antidepressant use is associated with diabetes onset and weight gain. Evidence across the remaining outcome domains was sparse, inconsistent and generally insufficient to support firm conclusions. There were no studies investigating long-term antidepressant use and broader outcomes such as quality of life, occupational functioning, cost-effectiveness or healthcare utilisation. This review exposes the lack of high-quality evidence for long-term antidepressant use, calling into question justification for the high and rising prevalence of long-term use internationally and highlighting the challenge of informed decision-making. Importantly the evidence for mental health symptoms, the primary clinical indication for these medicines, is sparse and inconsistent. Review findings suggest the need for regular antidepressant monitoring which includes assessment of weight and diabetes risk. High-quality research is needed to clarify the benefits and harms of both continuing antidepressants long-term and stopping long-term antidepressants to inform clinical care and enable people to make informed choices. Systematic review registration: PROSPERO: CRD42023446361
Key findings
- Forty-eight studies, mostly of weak- or moderate-quality, met inclusion criteria.
- Four weak-quality studies investigated mental health symptoms, including three RCT-extension studies investigating depressive symptoms with inconsistent findings.
- Forty-four observational studies examined eight other outcome domains: diabetes, weight and glucose homeostasis; dementia and cognitive performance; cancer; eye conditions; self-reported emotional, interpersonal and biological effects; functional limitation, falls and fracture in older people; Parkinson’s disease and levodopa-induced dyskinesia in people with Parkinson’s disease; and all-cause mortality and suicide.
- There is evidence that long-term antidepressant use is associated with diabetes onset and weight gain.
- Evidence across the remaining outcome domains was sparse, inconsistent and generally insufficient to support firm conclusions.
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Study details
- Study designsystematic review
- Evidence strengthHigh
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 47 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for sample size, effect reported and studied in people because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 29 of the 62 points we could judge it on, which is 47 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (PsyArXiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 29 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 29 of the 62 points we could judge it on is 47 out of 100. |
| Total | 47 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Wallis, K., McDonald, S., King, D. B., Liu, C., van Leeuwen, E., Moncrieff, J., et al. (2026). Long-term antidepressant use and outcomes in adults: A systematic review. PsyArXiv. https://doi.org/10.31234/osf.io/s4ej8_v1
Vancouver
Wallis K, McDonald S, King DB, Liu C, van Leeuwen E, Moncrieff J, et al. Long-term antidepressant use and outcomes in adults: A systematic review. PsyArXiv. 2026. doi:10.31234/osf.io/s4ej8_v1.
BibTeX
@article{wallis2026-05fbee68,
author = {Wallis, K. and McDonald, S. and King, D. B. and Liu, C. and van Leeuwen, E. and Moncrieff, J. and Horowitz, M. and Waller, M. and others},
title = {{Long-term antidepressant use and outcomes in adults: A systematic review}},
journal = {PsyArXiv},
year = {2026},
doi = {10.31234/osf.io/s4ej8_v1},
url = {https://doi.org/10.31234/osf.io/s4ej8_v1}
}
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