Venlafaxine Identification — MRCPsych Paper B MCQ

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ModerateMood DisordersVenlafaxine IdentificationMRCPsych Paper B

A 45-year-old man with major depressive disorder is switched from an SSRI to an SNRI. Before starting treatment, pre-existing hypertension should be controlled. Blood pressure should then be reviewed periodically after treatment initiation and after each dose increase because dose-related increases in blood pressure are commonly reported. Which antidepressant is this?

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Correct answer: E — Venlafaxine

Venlafaxine is the correct answer. It is an SNRI for which dose-related increases in blood pressure are commonly reported. The UK SmPC advises controlling pre-existing hypertension before initiation and reviewing blood pressure periodically after initiation and after dose increases. Duloxetine is the most plausible distractor: it is also an SNRI and may cause clinically significant hypertension, but its SmPC particularly recommends monitoring in patients with known hypertension or cardiac disease, especially during the first month. Duloxetine—not venlafaxine—is the SNRI licensed for diabetic peripheral neuropathic pain. Fluoxetine and sertraline are SSRIs, while mirtazapine is a noradrenergic and specific serotonergic antidepressant rather than a reuptake inhibitor.

Reference: Electronic Medicines Compendium. Venlafaxine XL 37.5 mg prolonged-release tablets, Summary of Product Characteristics, section 4.4 (blood pressure). 2025. https://www.medicines.org.uk/emc/product/4606/smpc