Depression — MRCPsych Paper B MCQ

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EasyMood DisordersDepressionMRCPsych Paper B

A 38-year-old woman presents to her GP with a first episode of less severe depression. Her PHQ-9 score is 11, and she has mild functional impairment with no suicidal or psychotic symptoms. She would like active treatment but has no preference for medication or psychological treatment. According to NICE NG222, which treatment should generally be considered first?

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Correct answer: B — Offer structured guided self-help

The correct answer is B. NICE recommends discussing all appropriate options and reaching a shared decision, but for a new episode of less severe depression, guided self-help should generally be considered first because it is the least intrusive and least resource-intensive active treatment. An antidepressant such as fluoxetine should not routinely be offered first-line in less severe depression unless it is the person’s informed preference. Venlafaxine is not an appropriate default initial antidepressant because SSRIs generally have a better safety and tolerability profile. Combined antidepressant treatment and individual CBT is more intensive than required here. Active monitoring is appropriate when the person does not want treatment or believes their symptoms are improving; this patient has requested active treatment.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.5.2–1.5.3, 2022, amended 2025. https://www.nice.org.uk/guidance/ng222/chapter/recommendations