Abstract
The aim of this narrative review was to collect and critically appraise the existing findings on the pharmacological treatment of depression in competitive athletes, with particular emphasis on antidepressant drugs from different classes and their impact on physical performance and anti-doping status. Material and methods. The PubMed, Scopus and Web of Science databases were searched for papers published between 1990 and 2025, combining terms related to depression, competitive sport and individual drug classes. Clinical studies, reviews and expert statements were included. Results. Selective serotonin reuptake inhibitors remain the first-line treatment owing to their favorable safety profile, although their adverse effects may affect training. Serotonin-noradrenaline reuptake inhibitors and bupropion require consideration of cardiovascular and thermoregulatory effects. Tricyclic antidepressants are now used less often because of cardiotoxicity. The anti-doping status of most drugs is permitted, yet some substances are subject to monitoring. Conclusions. Therapeutic decisions in athletes should be individualized, taking into account the discipline, the adverse-effect profile and anti-doping regulations. Randomized trials in this population are lacking.