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Relapse Prevention Depression — MRCPsych Paper B MCQ

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ModerateMood DisordersRelapse Prevention DepressionMRCPsych Paper B

A 52-year-old woman has experienced three episodes of depression over the past 4 years, each causing marked functional impairment. She achieved full remission from her most recent episode 1 year ago while taking sertraline 200 mg daily. She has no significant adverse effects and wishes to minimise her risk of relapse. According to NICE NG222, which is the most appropriate plan for the duration of antidepressant treatment?

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Correct answer: A — Continue sertraline at the effective dose, reviewing the need for treatment at least every 6 months

The correct answer is A. Her recurrent, relatively frequent episodes and associated marked functional impairment indicate a higher risk of relapse. NICE recommends considering continuation of the antidepressant that achieved remission, at the effective dose if tolerated, through shared decision-making. Treatment should be reviewed at least every 6 months, reassessing relapse risk, adverse effects and her preference to continue. NG222 does not mandate a fixed minimum of 2 years, so automatic stopping after another 6 months is unsupported. Remission for 1 year does not itself outweigh her relapse risk. Lifelong treatment is not automatically required and should not proceed without review. Lithium is not routinely substituted solely because a person has had three depressive episodes.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.8.1–1.8.5 and 1.8.11, 2022 (current guideline updated December 2025). https://www.nice.org.uk/guidance/ng222/chapter/Recommendations#preventing-relapse