skip to main content

Antidepressant Discontinuation — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateMood DisordersAntidepressant DiscontinuationMRCPsych Paper B

A 55-year-old man with recurrent depression has remained well while taking venlafaxine XL 300 mg daily. Following a review of his relapse risk, he makes a shared decision with his psychiatrist to discontinue treatment. Which advice about stopping venlafaxine is most consistent with NICE NG222?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Venlafaxine is more likely to cause withdrawal, so use an individualised stepwise taper that may take weeks or months.

Venlafaxine is specifically identified by NICE as being more likely to cause withdrawal symptoms, so particular care is required. The dose should be reduced stepwise, with the rate agreed with the patient and further reductions delayed until symptoms are absent or tolerable. Smaller proportional reductions may be needed at lower doses, and withdrawal can take weeks or months. Abrupt cessation or a rigid 1-week schedule is therefore inappropriate. Symptoms may include dizziness, electric-shock sensations, anxiety, sleep disturbance and nausea. NICE does not recommend routinely switching venlafaxine to fluoxetine for discontinuation. Alternate-day dosing is unsuitable as a general venlafaxine tapering strategy because fluctuating exposure may precipitate withdrawal; NICE discusses alternate-day dosing specifically as a possible method for fluoxetine 20 mg because of its prolonged action.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.4.12–1.4.21, particularly 1.4.16 and 1.4.18. 2022. https://www.nice.org.uk/guidance/ng222/chapter/recommendations