In recent years, the general trend of antidepressants is that they are being used more and more commonly and in higher and higher doses, and they are also being widely used by non-psychiatrists. Although most of the new antidepressant drugs are now safe, the side effects of such widespread use of antidepressant drugs cannot be ignored. There are many kinds of side effects of antidepressants, and one of the most important side effects that patients and their families are concerned about is the damage of the drug to the liver, but all kinds of psychiatric textbooks rarely introduce this side effect. In general, the safety of antidepressants on the liver is good, and the corresponding side effects are few and rarely lead to or induce liver damage. A recent review of articles on antidepressant-induced liver damage published from 1965 to the present found that asymptomatic mild transaminase elevation occurs in about 0.5% to 3% of patients, and this percentage is relatively low for newer antidepressants. 2. All antidepressants have the potential to cause or induce liver damage, especially in the elderly and in patients on multidrug combinations. Therefore, the elderly should use antidepressants with caution, and if they do, they should use antidepressants with low hepatotoxicity and in small doses, and avoid multi-drug combinations as much as possible, but the elderly often take other drugs, which requires weighing the pros and cons. 3. Damage to the liver is usually idiopathic and mostly unpredictable, appearing usually a few days to six months after the drug is administered. Therefore, after starting the drug, both the patient and the doctor should keep an eye on liver reactions, especially in the first six months after the drug is administered, and the most useful test is the monitoring of liver function transaminases. 4. Are there any liver side effects? Usually it has nothing to do with the dose of the drug. Some patients have liver side effects at very small doses, so we should not be careless because the patient is on a small dose. 5.The pathological basis of liver damage is mostly hepatocellular, with a few cholestatic and mixed types, and the damage to liver cells may be irreversible. The most serious hepatic side effect reported in the literature is fulminant liver failure and death, but this rarely occurs, and in all my years of clinical work in psychiatry, I have not witnessed such a serious hepatic side effect. In fact, I have used antidepressants for thousands of patients, and there was only one case of serious liver side effects, and that was more than 20 years ago. The patient developed generalized jaundice after using promethazine, but the patient did not have any other discomfort, and the jaundice gradually subsided more than 2 months after the medication was changed. 6, monoamine oxidase inhibitors and tricyclic antidepressants such old drugs have relatively large side effects on the liver, where there may be cross toxicity between tricyclic and tetracyclic antidepressants, while the new antidepressants now commonly used have relatively few side effects. Those with more and more severe hepatic side effects reported in the literature are, in order: isoproterenol, nafazodone, phenelzine, promethazine, amitriptyline, duloxetine, bupropion, triazolone, tianeptine, and agomelatine. Those with less hepatotoxicity reported in the literature are: cetaprotilam, escitalopram, paroxetine, and fluvoxamine.