Antidepressant Misuse in Esports: A Review of Pharmacology, Adverse Effects, Pharmacokinetics and Biomatrix-Based...

Esports has undergone rapid expansion over the past two decades, bringing with it challenges analogous to those observed in traditional athletic domains, particularly the misuse of performance-enhancing drugs (PEDs). Doping poses a dual threat to competitive integrity and player health, yet its manifestation in Esports remains insufficiently examined compared with conventional sports. This disparity has contributed to the under-recognition of substance misuse in professional gaming and the emergence of associated health risks among players. A lack of awareness among tournament organisers and regulatory bodies has further impeded the establishment of comprehensive anti-doping frameworks. To address this gap, the Esports Integrity Commission (ESIC) introduced a prohibited substances list tailored to the cognitive and psychological demands of Esports, acknowledging the limitations of the World Anti-Doping Agency (WADA) framework in this context. Substances commonly implicated in Esports doping include nootropics and other cognitive enhancers that improve attention, reaction speed and mental stamina. While stimulants such as medications for attention-deficit/hyperactivity disorder (ADHD) and energy drinks have been widely discussed, the non-medical use of antidepressants remains underexplored and insufficiently regulated despite their inclusion on ESIC monitoring lists. This review provides a critical synthesis of the pharmacology, pharmacokinetics, adverse effects and analytical detection strategies for antidepressants relevant to Esports doping. A co-citation analysis of 3756 references published between 2000 and 2025 was conducted to map the field's intellectual structure. Systematic screening identified 69 key studies that met predefined inclusion criteria and were analysed in detail.