Depression in Pregnancy First-Line — MRCPsych Paper B MCQ

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ModeratePerinatal PsychiatryDepression in Pregnancy First-LineMRCPsych Paper B

A 30-year-old woman at 18 weeks' gestation has persistent mild-to-moderate depression. She has no history of severe depression, mania, hypomania or psychosis, is not taking psychotropic medication, and has no immediate risk requiring urgent intervention. According to NICE CG192, which is the most appropriate initial intervention?

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Correct answer: A — Facilitated self-help using structured materials

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

B is correct. NICE CG192 recommends considering facilitated self-help for persistent subthreshold symptoms or mild-to-moderate depression during pregnancy. The absence of previous severe depression is important: antidepressant treatment may be considered when a woman presenting with mild depression has such a history. Fluoxetine is therefore not the routine initial intervention in this case, although an SSRI, SNRI or TCA may be appropriate for moderate or severe depression depending on previous response, risks and the woman's preferences. Treatment should not simply be deferred until delivery. Unstructured supportive counselling alone is not equivalent to the structured, manual-based facilitated self-help recommended by NICE. Lithium is a mood stabiliser and is not a treatment for uncomplicated unipolar depression.

Reference: National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192), recommendations 1.8.1–1.8.3. Published 2014; updated 2020. https://www.nice.org.uk/guidance/cg192/chapter/Recommendations