Confirming Antidepressant Failure — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

EasyMood DisordersConfirming Antidepressant FailureMRCPsych Paper B

An adult with depression reports no improvement after 4 weeks of antidepressant treatment. Before concluding that the antidepressant has not worked and moving to further-line treatment, which is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Confirm treatment at a recognised therapeutic dose for 4 weeks, assess adherence, and explore factors limiting response

The correct answer is A. NICE recommends that apparent antidepressant non-response should first be evaluated in the context of a recognised therapeutic dose given for an adequate period—4 weeks when there has been no response—together with adherence and factors that might impede improvement. These include adverse effects, personal or social difficulties, physical illness, other mental disorders and an incorrect diagnosis. Switching or increasing the dose may subsequently be considered through shared decision-making, but neither should occur automatically without this assessment. Antipsychotic augmentation is a specialist further-line strategy with additional adverse-effect burdens. ECT is reserved principally for severe depression when a rapid response is required or other treatments have been unsuccessful; it is not the routine response to one apparently unsuccessful antidepressant trial.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.4.3 and 1.9.1, 2022, current with amendments through December 2025. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations