A 74-year-old woman with severe depression and psychotic features (auditory hallucinations telling her she is worthless) has not responded to two adeq...

Question

A 74-year-old woman with severe depression and psychotic features (auditory hallucinations telling her she is worthless) has not responded to two adequate trials of SSRIs (Sertraline, then Citalopram, each for 8 weeks at therapeutic dose). She has no suicidal ideation. According to NICE CG90, what is the MOST appropriate next step?

Accepted Answer

Add an antipsychotic (e.g., Olanzapine or Quetiapine) to augment the antidepressant, and consider referral to secondary care mental health services

Answer

Start a third SSRI

Answer

Prescribe Diazepam for her anxiety symptoms

Answer

Discharge from mental health follow-up as two treatments have failed

Answer

Switch to St John's Wort

uk-dgm MCQ (SBA): Depression with Psychotic Features - Treatment