Depression — MRCGP AKT MCQ

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EasyPsychiatryDepressionMRCGP AKT UKMLA PARA

A 42-year-old man has a new episode of moderate depression. He has no psychotic symptoms, history of mania or immediate suicide risk. After discussing the available first-line treatments, he says that he would prefer combined medication and individual psychological therapy. Which is the most appropriate management?

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Correct answer: C — Offer an SSRI with individual CBT

The correct answer is **C: offer an SSRI with individual CBT**. NICE classifies moderate depression as more severe depression and lists combined individual CBT and an antidepressant among the first-line options. Treatment should be selected through shared decision-making; this patient explicitly prefers combined therapy. SSRIs are generally preferred when starting an antidepressant because of their tolerability and safety profile. Benzodiazepines do not treat the core depressive illness and carry dependence risks. Combining two antidepressants is a further-line strategy that may require specialist input because of increased adverse effects and potentially hazardous interactions. Antipsychotics are not first-line monotherapy for non-psychotic depression. Active monitoring alone is inappropriate given moderate symptoms and the patient's wish for active treatment.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management. NICE guideline NG222, sections 1.4 and 1.6, 2022; reviewed 2026. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations