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Anorexia and SSRIs — MRCPsych Paper B MCQ

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HardEating DisordersAnorexia and SSRIsMRCPsych Paper B

A 28-year-old woman with binge–purge anorexia nervosa has a BMI of 17.5 kg/m² and recurrent self-induced vomiting. She is receiving specialist eating-disorder treatment, and her GP is considering fluoxetine for a separate moderate depressive episode. Which statement best reflects the medication risk-management advice in NICE NG69?

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Reveal the answer and explanation

Correct answer: B — Account for malnutrition and compensatory behaviours because they can alter medication effectiveness and the risk of side effects.

Explanation lettering: D = shown as C · C = shown as D

B is correct. NICE NG69 advises that, when medication is prescribed for a comorbid condition, the effects of malnutrition and compensatory behaviours on medication effectiveness and adverse-effect risk must be considered. Low weight and vomiting may alter drug response, absorption and toxicity, but SSRIs are not absolutely contraindicated at a specified BMI. Fluoxetine is not a pharmacological treatment for anorexia nervosa, and its use for depression does not remove eating-disorder-specific prescribing considerations. Cardiac assessment is individualised: NICE recommends ECG monitoring when the medication or clinical factors could compromise cardiac functioning, rather than assuming that every SSRI prescription inevitably prolongs QTc. Thus A invents a threshold, C incorrectly equates anorexia nervosa with bulimia nervosa, D ignores relevant risks, and E overstates a conditional cardiac concern.

Reference: National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69), recommendations 1.8.14–1.8.17. Updated 2025. https://www.nice.org.uk/guidance/ng69/resources/eating-disorders-recognition-and-treatment-pdf-1837582159813