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OCD and Depression Comorbidity — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersOCD and Depression ComorbidityMRCPsych Paper B

A 40-year-old man has an 8-year history of obsessive-compulsive disorder and has developed a less severe depressive episode during the past 3 months as his OCD-related disability has increased. He has no suicidal intent or psychotic symptoms and remains able to engage in psychological treatment. Which initial management approach is most consistent with NICE guidance?

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Reveal the answer and explanation

Correct answer: B — Prioritise OCD-specific treatment while monitoring his depression and suicide risk

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

NICE NG222 distinguishes anxiety symptoms occurring within depression from a diagnosed anxiety disorder comorbid with depression. In the latter situation, clinicians should consider treating the anxiety disorder first. Here, longstanding OCD predates and appears to drive the less severe depression; there is no immediate suicide risk or inability to engage in treatment. Therefore, OCD-specific treatment should be prioritised, with ongoing monitoring of mood and suicide risk. Depending on OCD-related impairment and preference, treatment may involve CBT with exposure and response prevention, an SSRI, or both. A reverses the appropriate priority. C disregards stepped care and shared decision-making. Depression does not contraindicate CBT with ERP, so D is incorrect. E would fragment rather than coordinate care.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendation 1.2.13, 2022; reviewed 2026. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations