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Depression and Chronic Pain — MRCPsych Paper B MCQ

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EasyMood DisordersDepression and Chronic PainMRCPsych Paper B

A 65-year-old man has major depressive disorder that has not responded to an adequate therapeutic trial of sertraline despite good adherence. He also has painful diabetic peripheral neuropathy. Following review and shared decision-making, a switch to another antidepressant is planned. He has no severe renal impairment, hepatic impairment or uncontrolled hypertension. Which antidepressant is most likely to provide therapeutic benefit for both conditions?

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Correct answer: B — Duloxetine

Duloxetine is an SNRI licensed in the UK for both major depressive disorder and diabetic peripheral neuropathic pain. NICE also includes duloxetine among the initial pharmacological options for neuropathic pain, making it the best choice when a switch of antidepressant is already planned and there are no relevant contraindications. Sertraline treats depression but does not have an established role as a neuropathic-pain treatment. Mirtazapine, agomelatine and trazodone may be used for depression in selected circumstances, but they do not have the same guideline-supported dual indication. Duloxetine should be avoided in severe renal impairment, hepatic impairment and uncontrolled hypertension, and the previous SSRI should be withdrawn using an appropriate switching strategy.

Reference: Duloxetine 30 mg gastro-resistant capsules, Summary of Product Characteristics, sections 4.1 and 5.1, current SmPC accessed 19 August 2026: https://www.medicines.org.uk/emc/product/100749/smpc