Purpose of Review <p>Alcohol use disorder (AUD) and major depressive disorder (MDD) frequently co-occur, with each disorder exacerbating the severity, relapse risk, and treatment resistance of the other. Despite the well-documented risks of untreated depression in individuals with AUD, the role of selective serotonin reuptake inhibitors (SSRIs) remains contentious. This review critically examines the evidence behind recent clinical guidelines, particularly in Canada, discouraging SSRI use in patients with AUD-MDD.</p> Recent Findings <p>In 2023, the Canadian Medical Association Journal (CMAJ) issued national guidelines that strongly discourage SSRI use in AUD-MDD due to concerns about limited efficacy and the potential for increased alcohol consumption in some subgroups. However, accumulating evidence suggests that SSRIs are effective for individuals with primary MDD, including those with comorbid AUD. Moreover, many patients initially classified as having alcohol-induced depression later meet criteria for independent MDD. The CMAJ guideline does not offer viable alternatives to SSRIs, lacks guidance on safe deprescribing, and fails to consider post-acute withdrawal contributions to mood instability. Other international guidelines (e.g., APA, WHO) offer more individualized recommendations, highlighting inconsistencies in global practice.</p> Summary <p>The CMAJ guideline’s broad deprescribing stance may lead to undertreatment of MDD in patients with AUD, potentially worsening outcomes such as relapse and suicidality. A more nuanced, individualized approach is warranted. Future research should examine predictors of SSRI response, long-term treatment effects, and care models that integrate addiction and psychiatric services. Clinical guidelines should reflect the complexity of co-occurring AUD-MDD and support evidence-based decision-making over categorical medication avoidance.</p>