Fluoxetine CYP — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryFluoxetine CYPMRCPsych Paper B

A 15-year-old with moderate to severe depression has shown no meaningful improvement after 6 sessions of individual cognitive behavioural therapy. Following multidisciplinary review and assessment by a child and adolescent psychiatrist, antidepressant medication is to be started alongside ongoing psychological therapy. Which SSRI does NICE recommend?

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Correct answer: A — Fluoxetine

Fluoxetine is the correct answer. NICE recommends fluoxetine when an antidepressant is prescribed for moderate to severe depression in a child or young person because its clinical-trial evidence shows that benefits outweigh risks. Antidepressants should generally be used with concurrent psychological therapy, with careful monitoring, and prescribing should follow assessment and diagnosis by a child and adolescent psychiatrist. Sertraline and citalopram are potential second-line treatments only when fluoxetine is unsuccessful or not tolerated and additional NICE criteria are met. Paroxetine should not be used for depression in children and young people. Escitalopram is not recommended by NICE as the initial antidepressant in this context.

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 1.6.22–1.6.26. 2019; last reviewed 2024. https://www.nice.org.uk/guidance/ng134/chapter/Recommendations