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Major depressive disorder — MCCQE Part 1 MCQ

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EasyDepressionMajor depressive disorderMCCQE Part 1

42-year-old woman presents with low mood and anhedonia for 8 weeks. She has insomnia, poor concentration and guilt but no psychosis or mania. Which of the following is the most appropriate next step?

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Correct answer: E — Assess suicide risk and offer evidence-based psychotherapy and/or antidepressant treatment

Assess suicide risk and offer evidence-based psychotherapy and/or antidepressant treatment is best because duration and symptom cluster meet MDD criteria. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Always ask directly about suicidality in depression.

Reference: CANMAT 2023 Depression Guidelines