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Antidepressants in Dementia Depression — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryAntidepressants in Dementia DepressionMRCPsych Paper B

A woman with mild to moderate dementia develops mild to moderate depression. She has no pre-existing severe mental health problem. According to NICE NG97, which is the most appropriate treatment approach?

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Correct answer: A — Consider psychological treatment and do not routinely offer an antidepressant

The correct answer is A. NICE NG97 recommends considering psychological treatments for mild to moderate depression or anxiety in people with mild to moderate dementia. Antidepressants, including SSRIs or mirtazapine, should not be offered routinely in this situation unless indicated for a pre-existing severe mental health problem. Therefore, neither routine antidepressant monotherapy nor routine combined treatment is recommended. NICE does not identify mirtazapine as a preferred first-line antidepressant in dementia. Active monitoring alone is also inadequate as a general answer because an appropriate psychological treatment should be considered. The recommendation is specific to mild to moderate depression in mild to moderate dementia and should not be extrapolated uncritically to severe depression or other compelling psychiatric indications.

Reference: NICE. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.7.11–1.7.12. Published 2018; last reviewed 24 October 2025. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations