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Adolescent Depression Dose Increase — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryAdolescent Depression Dose IncreaseMRCPsych Paper B

A 16-year-old girl of higher body weight is receiving specialist CAMHS treatment for a severe depressive episode. She has engaged with concurrent individual CBT and has taken fluoxetine 20 mg daily for 6 weeks with confirmed adherence. She has tolerated it well and has shown a partial but inadequate response. Following clinical review, what is the most appropriate next pharmacological step according to NICE NG134?

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Correct answer: E — Cautiously increase the fluoxetine dose above 20 mg daily

The correct answer is E. NICE notes that evidence for fluoxetine doses above 20 mg daily in children and young people is limited, but cautious use of a higher dose may be considered in an older adolescent of higher body weight and/or in severe illness. Here, confirmed adherence, good tolerability and partial response support optimisation before switching. Sertraline is a second-line option when fluoxetine is unsuccessful or not tolerated, subject to specialist safeguards, rather than the best immediate choice after partial response. Lithium augmentation is not the recommended next step in this scenario. NICE specifically advises that venlafaxine and tricyclic antidepressants should not be used to treat depression in children and young people.

Reference: National Institute for Health and Care Excellence. NG134, Depression in children and young people: identification and management, recommendations 1.6.19 and 1.6.22–1.6.27. 2019; last reviewed 2024. https://www.nice.org.uk/guidance/ng134/chapter/Recommendations