Antidepressant Monitoring — MRCPsych Paper B MCQ

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ModerateMood DisordersAntidepressant MonitoringMRCPsych Paper B

A 65-year-old woman with depression is started on venlafaxine. Which monitoring parameter should be checked for pre-existing abnormality and then reviewed periodically after treatment initiation and dose increases?

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Correct answer: E — Blood pressure

The correct answer is E, blood pressure. Venlafaxine causes dose-related increases in blood pressure, occasionally severe, so the UK SmPC requires screening for pre-existing hypertension (which must be controlled before initiation) and periodic blood pressure review after starting treatment and after each dose increase; the Maudsley Prescribing Guidelines give the same advice. Renal and hepatic impairment alter venlafaxine clearance and may require dose reduction, but routine serial eGFR or alanine aminotransferase surveillance is not mandated in a patient without known organ impairment. Serum prolactin monitoring belongs principally with prolactin-raising antipsychotics such as risperidone or amisulpride, and thyroid-stimulating hormone monitoring is characteristic of lithium therapy, not venlafaxine. The discriminating stem feature is the requirement for baseline checking plus periodic review after initiation and dose increases, which uniquely matches venlafaxine's hypertension surveillance.

Reference: Electronic Medicines Compendium, Venlafaxine XL 37.5 mg prolonged-release tablets, Summary of Product Characteristics, section 4.4 (blood pressure), 2025. https://www.medicines.org.uk/emc/product/4606/smpc