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Depression and PD — MRCPsych Paper B MCQ

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ModerateMood DisordersDepression and PDMRCPsych Paper B

A 27-year-old woman has a current depressive episode and a coexisting diagnosis of emotionally unstable personality disorder. She is not currently receiving treatment for depression. According to NICE NG222, which management approach should be considered?

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Correct answer: D — Combine antidepressant medication with an evidence-based psychological treatment for depression

The correct answer is D. NICE NG222 states that treatment for depression should not be withheld because a personality disorder is present. For depression with a coexisting personality disorder, clinicians should consider combining antidepressant medication with an evidence-based psychological treatment such as behavioural activation, CBT, interpersonal psychotherapy or short-term psychodynamic psychotherapy. Treatment should be supported within a structured, multidisciplinary setting and may be extended for up to one year if necessary. Referral to a specialist personality disorder programme may also be considered, but depression treatment should not be deferred pending that intervention, so A is incorrect. Depressive syndromes can be diagnosed separately from personality disorder, excluding C. Neither medication nor psychological therapy is categorically ineffective or contraindicated in this context, excluding D and E.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), section 1.11, Depression in people with a diagnosis of personality disorder. 2022; reviewed 2026. https://www.nice.org.uk/guidance/ng222/chapter/recommendations