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Esketamine NICE Recommendation — MRCPsych Paper B MCQ

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HardMood DisordersEsketamine NICE RecommendationMRCPsych Paper B

A 55-year-old man has a current moderate to severe depressive episode that has not responded to two different antidepressants given at adequate dose and duration. His psychiatrist is considering esketamine nasal spray alongside an oral antidepressant. Which statement most accurately reflects the current recommendation in NICE technology appraisal guidance TA854?

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Reveal the answer and explanation

Correct answer: E — It is not recommended within its marketing authorisation for treatment-resistant depression.

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

B is correct. NICE TA854 states that esketamine nasal spray with an SSRI or SNRI is not recommended, within its marketing authorisation, for adults whose current moderate to severe depressive episode has not responded to at least two antidepressants. Although evidence suggested possible short-term benefit, NICE considered the clinical evidence insufficiently generalisable, the long-term benefits uncertain, and the economic modelling too uncertain to establish acceptable cost effectiveness. The recommendation remained unchanged following NICE review. A incorrectly treats the licensed indication as a positive NICE recommendation. C reflects the company's proposed later-line positioning, not NICE approval. D is not a recommendation made by TA854, and prior ECT failure is not its eligibility criterion. E is also incorrect: NICE recommended further research but did not issue an 'only in research' recommendation.

Reference: National Institute for Health and Care Excellence. Esketamine nasal spray for treatment-resistant depression, TA854, section 1: Recommendations. 2022; recommendation reviewed without change in 2024. https://www.nice.org.uk/guidance/ta854/chapter/1-Recommendations