Mood disorders: treatment-resistant depression: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Mood disorders: treatment-resistant depression

Sample item

A patient with major depression has not responded to adequate trials of two antidepressants of different classes. Which is an evidence-based next step?

ARepeat the same drug at a lower doseBAdd a second benzodiazepineCStop all treatment for six monthsDAugmentation with lithium or an atypical antipsychotic, or consider ECT

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Augmentation with lithium or an atypical antipsychotic, or consider ECT

Treatment-resistant depression is usually defined as failure of two adequate trials. Options include augmenting with lithium, an atypical antipsychotic such as quetiapine or aripiprazole, or triiodothyronine, switching class, using esketamine and using ECT. Adequacy of dose, duration and adherence should be confirmed first.

Option by option

A. Repeat the same drug at a lower dose
Lowering the dose of a drug that failed is unlikely to help.
B. Add a second benzodiazepine
Benzodiazepines are not antidepressants and increase dependence risk.
C. Stop all treatment for six months
Stopping treatment leaves a resistant illness untreated.
D. Augmentation with lithium or an atypical antipsychotic, or consider ECT (correct)
Correct. Augmentation or ECT is appropriate after two failed adequate trials.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, Augmentation with lithium or an atypical antipsychotic, or consider ECT. Treatment-resistant depression is usually defined as failure of two adequate trials.

Why is "Repeat the same drug at a lower dose" not the answer?

Lowering the dose of a drug that failed is unlikely to help.

Why is "Add a second benzodiazepine" not the answer?

Benzodiazepines are not antidepressants and increase dependence risk.

Why is "Stop all treatment for six months" not the answer?

Stopping treatment leaves a resistant illness untreated.

What concept does this question test?

It tests Mood disorders: treatment-resistant depression in Psychiatry. Options include augmenting with lithium, an atypical antipsychotic such as quetiapine or aripiprazole, or triiodothyronine, switching class, using esketamine and using ECT. Adequacy of dose, duration and adherence should be confirmed first.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Mood disorders: treatment-resistant depression?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.