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Severe Depression — MRCPsych Paper B MCQ

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ModerateMood DisordersSevere DepressionMRCPsych Paper B

A 60-year-old man with recurrent depressive disorder is being reviewed after two adequate SSRI trials produced no meaningful improvement. Which additional clinical finding would most clearly support considering electroconvulsive therapy now, according to NICE?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Severe depression with refusal of food and fluids, creating immediate danger to life

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

C is correct. NICE recommends considering ECT for severe depression when a rapid response is required—for example, when the illness is life-threatening because the person is not eating or drinking—or when other treatments have been unsuccessful. Refusal of food and fluids with immediate danger to life therefore provides the clearest indication. Psychotic symptoms may require specialist treatment, but improvement on antidepressant–antipsychotic therapy makes ECT less compelling (A). A single unsuccessful antidepressant trial in moderate depression is insufficient (B). Persistent depressive disorder with anxiety but no severe impairment (D), and uncomplicated bereavement-related symptoms without major risk or severe illness (E), do not meet these criteria.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), section 1.13.1, Electroconvulsive therapy for depression. 2022. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations