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Adolescent Depression — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryAdolescent DepressionMRCPsych Paper B

A 15-year-old girl with moderate to severe depression has adhered to 12 sessions of individual CBT but has shown no clinically significant improvement. Following multidisciplinary review, the diagnosis and adequacy of treatment are confirmed, and no comorbid condition or persisting psychosocial factor indicates a different intervention. According to NICE NG134, which treatment should now be offered?

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Correct answer: A — Add fluoxetine while continuing CBT

The correct answer is A. NICE recommends multidisciplinary review when moderate to severe depression has not responded after 4 to 6 sessions of psychological therapy. Following that review, fluoxetine should be offered to a young person aged 12 to 18 years, alongside concurrent psychological therapy. Twelve adequately attended CBT sessions clearly exceed the response-assessment threshold. Sertraline is a second-line option only if an adequate combined trial of fluoxetine and psychological therapy is unsuccessful or fluoxetine is not tolerated, subject to additional criteria. Venlafaxine should not be used for depression in children and young people. Family therapy may be considered when CBT is unsuitable or when clinical, family or psychosocial factors indicate it, but it is not the default next step in this scenario.

Reference: National Institute for Health and Care Excellence. Depression in children and young people: identification and management (NG134), recommendations 1.6.8–1.6.16. 2019; last reviewed 7 May 2024. https://www.nice.org.uk/guidance/ng134/chapter/Recommendations