# PLAB 1 Depression Questions: 10 Free Practice MCQs > 10 free PLAB 1 depression questions with answers and explanations, from a bank of 13 depression questions. Try them now, no sign up. Canonical: https://medhub.one/practice/plab-1/depression Last updated: 2026-10-31 Depression questions test severity and risk. The MLA content map expects a structured assessment, direct questions about suicide, and a treatment choice that matches severity: watchful waiting and psychological therapy for mild illness, antidepressants plus therapy for moderate to severe illness. The exam also tests the patient who stops treatment abruptly, and the somatic presentation that hides the diagnosis. ## Where candidates lose marks * Missing suicidal intent because the question was not asked directly. * Starting an antidepressant for mild depression without offering a psychological therapy first. * Stopping an antidepressant abruptly and causing discontinuation symptoms. * Forgetting to screen for bipolar disorder before starting an antidepressant. **Guideline to follow:** PLAB 1 follows NICE NG222 for depression in adults and the NICE guidance on self harm, with GMC guidance on confidentiality and risk. Ten PLAB 1-style depression questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 13 depression questions and many more across every topic. [Free timed mock exam](https://medhub.one/practice/plab-1/mock) 1. 1 / 10 A 30-year-old patient diagnosed with moderate major depressive disorder is commenced on sertraline 50 mg daily following a full clinical evaluation. What is the typical time frame for therapeutic effect? Show answer **Answer: B.** 2-4 weeks **Why:** Selective serotonin reuptake inhibitors (SSRIs) like sertraline typically require 2-4 weeks of regular adherence to exhibit clinical anti-depressive efficacy due to delayed neuroadaptive changes. Therapeutic response is not immediate or evident within days, nor should full effect take up to 3 months before reassessing response or dosage. * **A.** Too soon. * **C.** Too long. * **D.** Placebo effect maybe, but not pharmacological. Sources: NICE CG90 2. 2 / 10 A 30-year-old woman is assessed for depression. She reports a 3-month history of low mood, but notes that her mood temporarily brightens in response to positive events (e.g. a visit from a friend). She also reports sleeping 11 hours per night, increased appetite with a 5 kg weight gain, and a heavy, lead-like sensation in her arms and legs. What is the most likely diagnosis? Show answer **Answer: D.** Depression with atypical features **Why:** Depression with atypical features is a subtype of major depressive disorder. Unlike melancholic depression, patients retain mood reactivity (the ability to feel better when something good happens). Somatic symptoms are reversed compared to classic depression: hypersomnia instead of insomnia, and hyperphagia/weight gain instead of anorexia/weight loss. It also features leaden paralysis and rejection sensitivity. * **A.** Melancholic depression is characterized by lack of mood reactivity, early morning waking, weight loss, and marked psychomotor agitation or retardation. * **B.** Dysthymia (persistent depressive disorder) is a chronic low mood lasting at least 2 years, whereas this patient has an acute 3-month episode with distinct atypical features. * **C.** Bipolar II requires a history of at least one hypomanic episode alongside major depression, which is not mentioned in her history. Sources: Oxford Handbook of Psychiatry; DSM-5 Criteria for Depressive Subtypes 3. 3 / 10 A 19-year-old has taken fluoxetine for two weeks for depression. He has improved slightly, denies suicidal thoughts and has no significant adverse effects. What is the best management now? Show answer **Answer: D.** Continue fluoxetine and arrange review of response, side effects and suicide risk **Why:** Continue the current treatment and review symptoms, adverse effects, adherence and suicide risk. Two weeks is too early to label the antidepressant ineffective, and this 19-year-old needs early monitoring. * **A.** Two weeks is too early to judge full benefit; stopping now risks interrupting a potentially effective treatment. * **B.** Benzodiazepines are not a routine treatment for depression and carry risks such as dependence and sedation. * **C.** Residual symptoms at two weeks do not establish treatment failure; there are no features here requiring specialist referral. Sources: NICE NG222, recommendations 1.4.3 and 1.4.22 4. Like these? UK.med has a bank of 1999 questions, plus timed mock exams. Free to start: [App Store](https://apps.apple.com/app/id6760537451?utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=plab-1) · [Google Play](https://play.google.com/store/apps/details?id=com.medicinahub.ukmed&utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=plab-1) 5. 4 / 10 In England, a 68-year-old admitted with severe psychotic depression is stuporous, has stopped eating and drinking, and refuses nasogastric feeding because she believes her organs have rotted. The team is considering urgent treatment to prevent serious physical harm. What should the team do first about the refusal? Show answer **Answer: A.** Assess her capacity for the feeding decision and establish what support she needs **Why:** The team must assess capacity for this particular feeding decision and support her to decide. If she lacks capacity, treatment must be considered in her best interests and be proportionate; a Court of Protection application is not automatic. A diagnosis of depression or psychosis does not itself prove incapacity. If she lacks capacity, the team should consult her about wishes and values and choose a proportionate option; a court application is needed only when required by the circumstances or law. * **B.** A mental disorder does not automatically remove capacity; a lawful best-interests decision is needed if she lacks capacity. * **C.** Relatives cannot consent for an adult unless they hold a relevant legal authority, such as a health and welfare lasting power of attorney. * **D.** A decision about resuscitation is separate and cannot be inferred from refusal of nutrition. Sources: Mental Capacity Act 2005, sections 1 to 4; NICE NG222 6. 5 / 10 A 35-year-old woman with a history of recurrent major depressive disorder is started on a selective serotonin reuptake inhibitor (SSRI). She has no history of self-harm or suicidal ideation. She attends her follow-up appointment 2 weeks later and reports feeling slightly better but still experiencing low mood. What is the most appropriate next step in managing this patient's depression? Show answer **Answer: C.** Monitor the patient's symptoms and adjust the treatment plan as necessary **Why:** Regular monitoring and adjustment of treatment plans are essential in managing depression. This allows the clinician to assess the patient's response to treatment and make any necessary changes to optimize outcomes. * **A.** Increasing the dose of an SSRI too quickly can increase the risk of side effects and may not be necessary for this patient. * **B.** While specialist input may be beneficial, this patient's symptoms are mild and may be managed in primary care. * **D.** Switching antidepressants too quickly can be ineffective and may cause unnecessary side effects. Sources: NICE Guideline NG23 7. 6 / 10 A 19-year-old reports seven weeks of low mood and loss of interest in football and friends. He has poor sleep, reduced appetite, low energy and impaired concentration, without past mania or hypomania. What is the most likely diagnosis? Show answer **Answer: B.** A depressive episode **Why:** The duration, low mood, anhedonia and associated symptoms with impairment support a depressive episode. The absence of mania or hypomania argues against bipolar disorder. * **A.** There is no history of mania or hypomania to support bipolar disorder. * **C.** No clear recent stressor is given, and the sustained depressive syndrome is more consistent with a depressive episode. * **D.** The vignette describes depressive symptoms rather than excessive worry across multiple areas. Sources: NICE NG222 8. 7 / 10 A 19-year-old taking fluoxetine for depression attends two weeks after starting it. He reports slight improvement and denies suicidal thoughts, but his GP remains concerned about risk and wants to agree a safety plan. What is the most appropriate next step? Show answer **Answer: C.** Review suicide risk, agree a collaborative safety plan and arrange close follow-up **Why:** The GP should assess current risk, agree a personalised safety plan and arrange close follow-up. NICE recommends review one week after starting an antidepressant for people aged 18 to 25 or when suicide risk is a concern. * **A.** A dose increase is not the response to a safety concern and needs a clinical review of benefit, harms and suicide risk. * **B.** Antidepressants may take several weeks to work; incomplete improvement at two weeks alone is not a reason to stop. * **D.** A denial at one appointment does not remove the need to address the GP’s concern and continue monitoring. Sources: NICE NG222, recommendations 1.4.11 and 1.4.22 9. 8 / 10 A 19-year-old has recently started fluoxetine for depression. He denies current intent to harm himself, but says he sometimes feels overwhelmed and agrees that his GP can help plan for a crisis. Which element belongs in a collaborative safety plan? Show answer **Answer: B.** Warning signs, coping strategies, supportive contacts and urgent services he can contact **Why:** A collaborative safety plan sets out warning signs, coping steps, supportive people and routes to urgent help. It should be reviewed alongside ongoing assessment and follow-up. * **A.** A no-suicide promise is not a substitute for assessing risk or making a practical safety plan. * **C.** Medication changes require review and do not provide an immediate response plan for a crisis. * **D.** An agreed plan complements continuing review; it does not replace monitoring. Sources: NICE NG222 10. 9 / 10 A 44-year-old man has been treated for moderate depression with Sertraline. He titrated the dose up to 150mg daily and has been taking it regularly with good compliance for 8 weeks. However, he has seen no improvement in his mood or energy levels. What is the most appropriate next step in pharmacological management according to NICE guidelines? Show answer **Answer: A.** Switch to an alternative class of antidepressant (e.g. Venlafaxine or Mirtazapine), or augment with a second agent after specialist advice **Why:** NICE guideline NG222 states that for patients with depression who show no response to an initial SSRI after 6-8 weeks of adequate dosing, compliance should be verified first. If compliant, options include: (1) switching to another SSRI, (2) switching to an antidepressant of a different class (e.g. Mirtazapine, Venlafaxine, or tricyclics), or (3) adding an augmenting agent (e.g. Aripiprazole, Quetiapine, or Lithium) under specialist advice. * **B.** The maximum licensed dose of Sertraline in the UK is 200mg daily. Increasing the dose to 300mg is outside the licensing limits and unsafe. * **C.** Combining an SSRI with an MAOI is strictly contraindicated due to the high risk of life-threatening Serotonin Syndrome. A washout period is required when switching between these drugs. * **D.** Stopping Sertraline abruptly will cause discontinuation symptoms. CBT should be offered, but if changing pharmacological therapy, weaning and switching are appropriate. Sources: NICE NG222 11. 10 / 10 A 19-year-old male is started on Fluoxetine 20mg daily for moderate-to-severe major depression. He has no history of self-harm or suicidal ideation. He attends his follow-up appointment 2 weeks later and reports feeling slightly better but still experiencing low mood. His GP is concerned about his risk of suicide and wants to implement a safety plan. Which of the following is the most appropriate next step in managing this patient's risk of suicide? Show answer **Answer: D.** Implement a safety plan with the patient, including regular follow-up appointments and a crisis hotline **Why:** A safety plan is a crucial component of suicide prevention, especially in high-risk patients. It involves identifying triggers for suicidal behavior, developing coping strategies, and establishing a network of support. In this case, the GP should work with the patient to develop a safety plan, including regular follow-up appointments and a crisis hotline. * **A.** Increasing the dose of an antidepressant without adequate monitoring can increase the risk of suicide. * **B.** While specialist input may be beneficial, it is not the most appropriate next step in managing this patient's risk of suicide. * **C.** Benzodiazepines are not recommended for the treatment of depression and can increase the risk of suicide. Sources: NICE Guideline NG23 ## Explore the 1999-question bank in UK.med Timed practice, spaced repetition and AI clinical simulations that grade you like an examiner. Free to start. [App Store](https://apps.apple.com/app/id6760537451?utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=plab-1)[Google Play](https://play.google.com/store/apps/details?id=com.medicinahub.ukmed&utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=plab-1) ## More topics * [Psychiatry78 questions in the app](https://medhub.one/practice/plab-1/psychiatry) * [Obstetrics & Gynaecology334 questions in the app](https://medhub.one/practice/plab-1/obstetrics-gynaecology) * [Cardiology219 questions in the app](https://medhub.one/practice/plab-1/cardiology) * [Paediatrics188 questions in the app](https://medhub.one/practice/plab-1/paediatrics) [Free PLAB 1 Practice Questions by Topic](https://medhub.one/practice/plab-1) · [Free timed mock exam](https://medhub.one/practice/plab-1/mock) [The PLAB and GMC registration pathway](https://medhub.one/platforms/uk-med/plab-gmc-registration-guide) Exam-style questions written by MedHub for practice. They are not official exam questions.