skip to main content

VNS in Depression — MRCPsych Paper B MCQ

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

HardMood DisordersVNS in DepressionMRCPsych Paper B

A 48-year-old woman has persistent severe depressive symptoms despite adequate trials of several antidepressants, evidence-based psychological therapy, pharmacological augmentation and electroconvulsive therapy. A specialist multidisciplinary team is considering implanted vagus nerve stimulation. Which statement most accurately reflects current NICE guidance?

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

Reveal the answer and explanation

Correct answer: D — It should be used only with special arrangements for clinical governance, consent, and audit or research because the efficacy evidence is limited in quality.

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

B is correct. NICE states that implanted VNS for treatment-resistant depression raises no major safety concerns, although frequent recognised adverse effects occur, including voice change, cough and dyspnoea. Because evidence of efficacy is limited in quality, it should be used only with special arrangements for clinical governance, consent, and audit or research. It is therefore not a routine treatment under standard governance arrangements (A). NICE encourages randomised sham-controlled research but does not restrict use exclusively to trials, because prospective audit is also permitted (C). Previous response to ECT may predict a better response, but it does not remove the special-arrangements requirement (D). Option E incorrectly characterises the safety evidence.

Reference: National Institute for Health and Care Excellence. Implanted vagus nerve stimulation for treatment-resistant depression, HTG551, section 1: Recommendations. 2020; migrated January 2026 with recommendations unchanged. https://www.nice.org.uk/guidance/htg551/chapter/1-Recommendations