Maintenance Antidepressant Duration — MRCPsych Paper B MCQ
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Correct answer: A — Continue sertraline for relapse prevention, review at least every 6 months, and agree the ongoing duration through shared decision-making
Explanation lettering: C = shown as A · E = shown as C · A = shown as E
C is correct. His recurrent episodes and previous recurrence after tapering indicate a higher risk of relapse. NICE NG222 does not prescribe a universal minimum of 2 years or recommend indefinite treatment solely because four episodes have occurred. For a higher-risk person who remitted with an antidepressant, NICE advises considering continuation at the dose that produced remission, unless there is a reason to reduce it. Treatment should be reviewed at least every 6 months, assessing mood, adverse effects, relapse risks and the person's preference about continuing. A and B impose fixed stopping dates not specified by NG222; 6 months is a typical minimum treatment period but is not an automatic stopping point in high-risk relapse prevention. D incorrectly converts evidence extending up to 2 years into a fixed duration recommendation. E disregards his substantial relapse risk.
Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.8.1–1.8.5 and 1.8.11, 2022; reviewed 30 January 2026. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations