skip to main content

Pregnancy Depression Rx — MRCPsych Paper B MCQ

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

ModeratePerinatal PsychiatryPregnancy Depression RxMRCPsych Paper B

A 30-year-old woman who is 22 weeks pregnant presents with a 6-week history of persistent low mood, anhedonia, impaired concentration and marked difficulty functioning at work. She meets criteria for a moderate depressive episode. This is her first episode, and she has no history of mania, psychosis or self-harm. She is not taking psychotropic medication and, after discussing the benefits and risks of treatment during pregnancy, states that she would prefer a psychological treatment. What is the most appropriate initial management?

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

Reveal the answer and explanation

Correct answer: B — Offer a high-intensity psychological intervention such as CBT

The correct answer is **B: offer a high-intensity psychological intervention such as CBT**. NICE recommends high-intensity psychological therapy as an option for moderate or severe depression during pregnancy. This woman has moderate depression, no immediate safety concerns and a clear informed preference for psychological treatment. Fluoxetine is not automatically first-line solely because she is in the second trimester; antidepressant use requires an individualised risk–benefit discussion and is particularly considered when medication is preferred, psychological treatment is declined or it has been ineffective. Deferring treatment risks continuing maternal illness and associated adverse consequences. Non-directive counselling alone is not the specified evidence-based intervention for moderate depression. Lithium is used principally for bipolar disorder 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), section 1.8, recommendation 1.8.3. Published 2014; last updated 2020. https://www.nice.org.uk/guidance/cg192/chapter/Recommendations