Adolescent Depression — MRCPsych Paper B MCQ

Correct answer: B — Offer digital CBT or a group psychological therapy

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

C is correct. For a young person aged 12 to 18 with mild depression persisting after 2 weeks of watchful waiting, without significant comorbidity or active suicidal ideas or plans, NICE recommends offering a choice of digital CBT, group CBT, group interpersonal psychotherapy, or group non-directive supportive therapy for approximately 2 to 3 months. Individual CBT or attachment-based family therapy may be considered if these options are unsuitable. Antidepressants should not be used as the initial treatment for mild depression, excluding fluoxetine and sertraline monotherapy. Combined fluoxetine and psychological therapy may be considered for moderate to severe depression, not the mild presentation described. Watchful waiting alone was appropriate initially but is not the best next step now that symptoms persist and she wants treatment.

Reference: National Institute for Health and Care Excellence. Depression in children and young people: identification and management (NG134), section 1.5, recommendations 1.5.1–1.5.8. 2019; last reviewed 2024. https://www.nice.org.uk/guidance/ng134/chapter/Recommendations