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Safety-critical antidepressant change — DOccMed MCQ

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HardFitness for WorkSafety-critical antidepressant changeDOccMed

A 38-year-old rail-track maintenance worker has recurrent depression and started mirtazapine 30 mg one week ago. He reports morning sedation, near-miss errors during possession work and a planned night shift rota next week. What is the most appropriate advice regarding fitness for work?

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Correct answer: E — Advise temporary removal from safety-critical night duties while sedation settles

The key risk is not the diagnosis alone but sedation affecting a safety-critical task. Early treatment changes can impair alertness, especially with night work. A temporary restriction from safety-critical duties, with review after symptom and medication stabilisation, is proportionate. Permanent redeployment would be premature.

Reference: FOM Fitness for Work guidance; NICE NG146