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Antidepressants in Renal Impairment — MRCPsych Paper B MCQ

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ModerateLiaison PsychiatryAntidepressants in Renal ImpairmentMRCPsych Paper B

A 60-year-old woman with a major depressive episode has stable chronic kidney disease. Her Cockcroft–Gault creatinine clearance is 25 mL/min. Liver function is normal, she takes no interacting medication, and antidepressant treatment is indicated. Which statement about initial prescribing is most accurate?

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Correct answer: E — Sertraline may be started at the usual adult dose because renal impairment alone does not require dose adjustment

Sertraline is extensively metabolised, with unchanged urinary excretion representing only a minor elimination route. Its SmPC states that renal impairment, including creatinine clearance of 10–29 mL/min, does not itself require dose adjustment. Usual clinical monitoring for antidepressant adverse effects remains necessary. Duloxetine is unsuitable here because its SmPC states that it must not be used when creatinine clearance is below 30 mL/min. Citalopram is not automatically contraindicated below 30 mL/min; its SmPC identifies insufficient information and recommends against use below 20 mL/min. Therefore, neither universal SSRI avoidance nor automatic sertraline dose reduction is justified.

Reference: Electronic Medicines Compendium. Sertraline 100 mg Tablets, Summary of Product Characteristics, sections 4.2 and 4.4, revised 2026. https://www.medicines.org.uk/emc/product/5759/smpc