Fluoxetine First-Line CYP — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryFluoxetine First-Line CYPMRCPsych Paper B

A 15-year-old with moderate-to-severe depression has not responded adequately after 6 sessions of individual cognitive behavioural therapy. Following multidisciplinary CAMHS review, antidepressant treatment alongside ongoing psychological therapy is indicated. Which SSRI should be offered?

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Correct answer: D — Fluoxetine

Fluoxetine is the correct answer. NICE recommends offering it after multidisciplinary review when moderate-to-severe depression in a young person has not responded to 4–6 sessions of a specific psychological therapy. Antidepressant treatment should normally be given with concurrent psychological therapy and monitored closely, including for emergent suicidality, self-harm or hostility. Sertraline and citalopram are second-line options only if an adequate trial of fluoxetine is unsuccessful or not tolerated, and their use in under-18s for depression is off label. Paroxetine should not be used to treat depression in children or young people. Escitalopram is not a NICE-recommended first- or second-line antidepressant for this indication.

Reference: National Institute for Health and Care Excellence. Depression in children and young people: identification and management (NG134), recommendations 1.6.10, 1.6.14, 1.6.16 and 1.6.22. 2019; last reviewed 7 May 2024. https://www.nice.org.uk/guidance/ng134/chapter/Recommendations