Depression MCQs With Answer

Depression MCQs With Answer provide B. Pharm students a focused, exam-ready way to master clinical pharmacology, pathophysiology, and therapeutics of depressive disorders. This concise, keyword-rich introduction covers antidepressant classes (SSRIs, SNRIs, TCAs, MAOIs, atypicals), mechanisms of action, pharmacokinetics, CYP interactions, adverse effects, monitoring, and special-population considerations. Questions emphasize evidence-based treatment, diagnostic scales (PHQ-9, HAM-D), serotonin syndrome, drug interactions, and management of treatment-resistant depression. Each MCQ is written to deepen your understanding for pharmacy practice, counselling, and safe dispensing. Clear answers reinforce learning and help prepare for university exams and hospital rotations. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the minimum duration of symptoms required to diagnose a major depressive episode according to DSM-5?

• 1 week
• 2 weeks
• 6 weeks
• 3 months

Correct Answer: 2 weeks

Q2. Which rating scale is specifically designed to screen for depressive symptoms in primary care and self-reporting?

• HAM-D (Hamilton Depression Rating Scale)
• Beck Depression Inventory (BDI)
• PHQ-9 (Patient Health Questionnaire-9)
• MADRS (Montgomery–Åsberg Depression Rating Scale)

Correct Answer: PHQ-9 (Patient Health Questionnaire-9)

Q3. Which hypothesis historically underpins many antidepressant mechanisms by implicating deficits in serotonin, norepinephrine, and dopamine?

• Neurotrophic hypothesis
• Monoamine hypothesis
• Inflammatory hypothesis
• Glutamatergic hypothesis

Correct Answer: Monoamine hypothesis

Q4. Which drug is a selective serotonin reuptake inhibitor (SSRI) with the longest half-life due to an active metabolite?

• Sertraline
• Fluoxetine
• Paroxetine
• Citalopram

Correct Answer: Fluoxetine

Q5. Which adverse effect is most commonly associated with SSRIs?

• Orthostatic hypotension
• Anticholinergic delirium
• Sexual dysfunction
• Severe QT prolongation in all patients

Correct Answer: Sexual dysfunction

Q6. Which antidepressant is primarily a norepinephrine–dopamine reuptake inhibitor (NDRI) and is often used when sexual side effects are a concern?

• Bupropion
• Mirtazapine
• Trazodone
• Venlafaxine

Correct Answer: Bupropion

Q7. Which antidepressant class is associated with significant anticholinergic effects and cardiac conduction abnormalities in overdose?

• SSRIs
• SNRIs
• Tricyclic antidepressants (TCAs)
• MAOIs

Correct Answer: Tricyclic antidepressants (TCAs)

Q8. Phenelzine is an example of which class of antidepressants and what is a key dietary restriction?

• SSRI; avoid grapefruit
• TCA; low-sodium diet
• MAOI; avoid tyramine-rich foods
• SNRI; avoid high-protein meals

Correct Answer: MAOI; avoid tyramine-rich foods

Q9. Which serotonin-related adverse reaction presents with agitation, hyperreflexia, autonomic instability, and can be life-threatening?

• Neuroleptic malignant syndrome
• Serotonin syndrome
• Anticholinergic syndrome
• Withdrawal syndrome

Correct Answer: Serotonin syndrome

Q10. First-line pharmacotherapy for moderate to severe unipolar depression in adults commonly includes which class?

• MAOIs
• SSRIs
• High-dose benzodiazepines
• First-generation antipsychotics

Correct Answer: SSRIs

Q11. Which antidepressant acts as an antagonist at central alpha-2 receptors and enhances noradrenergic and serotonergic transmission?

• Mirtazapine
• Venlafaxine
• Fluoxetine
• Bupropion

Correct Answer: Mirtazapine

Q12. A patient on an SSRI develops hyponatremia due to SIADH. Which population is at highest risk?

• Young adults aged 20–30
• Middle-aged men
• Elderly patients
• Infants

Correct Answer: Elderly patients

Q13. Which SNRI inhibits both serotonin and norepinephrine reuptake and is indicated for depression and neuropathic pain?

• Sertraline
• Venlafaxine
• Fluoxetine
• Amitriptyline

Correct Answer: Venlafaxine

Q14. Which pharmacokinetic interaction is most relevant for fluoxetine and paroxetine?

• Induction of CYP3A4 leading to decreased levels of co-medications
• Inhibition of CYP2D6 leading to increased levels of CYP2D6 substrates
• Increase in renal clearance of co-administered drugs
• No significant CYP interactions

Correct Answer: Inhibition of CYP2D6 leading to increased levels of CYP2D6 substrates

Q15. Which antidepressant is contraindicated with MAOIs because it can precipitate serotonin syndrome when combined?

• Bupropion
• Tranylcypromine
• SSRIs (e.g., sertraline)
• Mirtazapine

Correct Answer: SSRIs (e.g., sertraline)

Q16. Which agent is an NMDA receptor antagonist used for treatment-resistant depression with rapid onset of effect?

• Esketamine
• Phenelzine
• Imipramine
• Sertraline

Correct Answer: Esketamine

Q17. What is the recommended washout period when switching from fluoxetine to an MAOI to avoid serotonin syndrome?

• 5 days
• 7 days
• 14 days
• 28 days

Correct Answer: 28 days

Q18. Which antidepressant is associated with hepatotoxicity and requires caution or monitoring of liver function?

• Sertraline
• Nefazodone
• Escitalopram
• Bupropion

Correct Answer: Nefazodone

Q19. Which augmentation strategy has evidence for use in treatment-resistant depression?

• Adding lithium to an antidepressant
• Switching to benzodiazepine monotherapy
• Increasing SSRI dose beyond twice the maximum
• Combining two MAOIs

Correct Answer: Adding lithium to an antidepressant

Q20. What is a major contraindication to electroconvulsive therapy (ECT)?

• Uncontrolled hypertension or recent myocardial infarction without stabilization
• Unipolar depression
• Young age under 30
• Concurrent SSRI therapy

Correct Answer: Uncontrolled hypertension or recent myocardial infarction without stabilization

Q21. Which antidepressant is most likely to cause weight gain and increased appetite via H1 histamine antagonism?

• Fluoxetine
• Mirtazapine
• Sertraline
• Bupropion

Correct Answer: Mirtazapine

Q22. Which adverse effect is characteristic of tricyclic antidepressant overdose and is treated with intravenous sodium bicarbonate?

• Serotonin syndrome
• Severe anticholinergic diarrhea
• Cardiac conduction block and wide QRS
• Acute hepatic failure

Correct Answer: Cardiac conduction block and wide QRS

Q23. Which antidepressant can lower seizure threshold and is relatively contraindicated in patients with seizure disorders?

• Bupropion
• Escitalopram
• Sertraline
• Mirtazapine

Correct Answer: Bupropion

Q24. Which lab or clinical parameter should be monitored when starting an SNRI like venlafaxine at higher doses?

• Serum potassium
• Blood pressure
• Blood glucose
• Serum magnesium

Correct Answer: Blood pressure

Q25. Which herbal supplement commonly used for mild depression has significant interactions with SSRIs and can increase serotonin risk?

• Omega-3 fatty acids
• St. John’s Wort (Hypericum)
• Ginkgo biloba
• Echinacea

Correct Answer: St. John’s Wort (Hypericum)

Q26. For pregnant patients with depression, which SSRI has been associated with increased risk of congenital cardiac malformations and is usually avoided if possible?

• Paroxetine
• Sertraline
• Fluoxetine
• Citalopram

Correct Answer: Paroxetine

Q27. What is the black box warning common to most antidepressants regarding younger patients?

• Risk of dependency
• Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults
• Severe hepatic failure
• Irreversible sexual dysfunction

Correct Answer: Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults

Q28. Which antidepressant is indicated particularly for depression with prominent insomnia due to sedative properties at lower doses?

• Trazodone
• Fluoxetine
• Bupropion
• Venlafaxine

Correct Answer: Trazodone

Q29. Which mechanism best describes mirtazapine’s action on serotonergic receptors contributing to antidepressant effects?

• 5-HT1A direct agonism
• 5-HT2 and 5-HT3 antagonism with increased 5-HT1-mediated transmission
• Inhibition of serotonin synthesis
• MAO-A inhibition

Correct Answer: 5-HT2 and 5-HT3 antagonism with increased 5-HT1-mediated transmission

Q30. Which antidepressant requires measurement of plasma levels to guide dosing in some cases due to narrow therapeutic index?

• Sertraline
• Amitriptyline (TCA)
• Escitalopram
• Venlafaxine

Correct Answer: Amitriptyline (TCA)

Q31. Which condition must be ruled out before starting an antidepressant because antidepressants can induce mania in this disorder?

• Panic disorder
• Bipolar disorder
• Generalized anxiety disorder
• Dysthymia

Correct Answer: Bipolar disorder

Q32. Which neurotransmitter system is the primary target of ketamine’s rapid antidepressant action?

• Serotonergic system
• GABAergic system
• Glutamatergic (NMDA receptor blockade)
• Dopaminergic D2 receptor antagonism

Correct Answer: Glutamatergic (NMDA receptor blockade)

Q33. What is the typical onset of clinical improvement with standard SSRI therapy?

• Few hours
• 1–3 days
• 2–4 weeks, with full effect often 6–8 weeks
• 6 months

Correct Answer: 2–4 weeks, with full effect often 6–8 weeks

Q34. Which antidepressant is associated with significant risk of QT interval prolongation at higher doses and requires caution?

• Citalopram
• Sertraline
• Bupropion
• Fluvoxamine

Correct Answer: Citalopram

Q35. Which clinical feature differentiates bipolar depression from unipolar major depression and affects pharmaceutical choice?

• Presence of psychomotor retardation
• History of manic or hypomanic episodes
• Insomnia
• Weight loss

Correct Answer: History of manic or hypomanic episodes

Q36. Which antidepressant is a useful choice in depressed patients who also need smoking cessation support?

• Mirtazapine
• Bupropion
• Fluoxetine
• Amitriptyline

Correct Answer: Bupropion

Q37. Which medication is an example of an irreversible MAOI used in refractory depression?

• Phenelzine
• Sertraline
• Venlafaxine
• Esketamine

Correct Answer: Phenelzine

Q38. Which antidepressant is associated with risk of hepatotoxicity and is no longer widely used because of this risk?

• Nefazodone
• Fluoxetine
• Sertraline
• Escitalopram

Correct Answer: Nefazodone

Q39. What is the main clinical concern when combining SSRIs with anticoagulants like warfarin?

• Reduced anticoagulant effect causing clot risk
• Increased bleeding risk due to platelet dysfunction and CYP interactions
• Acute hypertensive crisis
• Severe hyperglycemia

Correct Answer: Increased bleeding risk due to platelet dysfunction and CYP interactions

Q40. Which antidepressant’s effectiveness is increased by concomitant CYP2D6 metabolism and may require dose adjustment in CYP2D6 poor metabolizers?

• Fluoxetine (active inhibitor of CYP2D6)
• Tranylcypromine (MAOI)
• Amitriptyline (TCA)
• Esketamine

Correct Answer: Amitriptyline (TCA)

Q41. Which treatment has FDA approval specifically for postpartum depression and acts as a neuroactive steroid (GABA-A modulator)?

• Fluoxetine
• Brexanolone
• Venlafaxine
• Bupropion

Correct Answer: Brexanolone

Q42. Which medication is least likely to cause sexual dysfunction among common antidepressants?

• Paroxetine
• Sertraline
• Bupropion
• Fluoxetine

Correct Answer: Bupropion

Q43. Which antidepressant class requires dietary tyramine restrictions to prevent hypertensive crises?

• SSRIs
• SNRIs
• MAOIs
• TCAs

Correct Answer: MAOIs

Q44. What is a common and clinically significant withdrawal phenomenon when abruptly stopping many SSRIs (except fluoxetine)?

• Serotonin syndrome
• Discontinuation syndrome with dizziness, irritability, flu-like symptoms
• Immediate relapse into mania
• Acute hypertensive crisis

Correct Answer: Discontinuation syndrome with dizziness, irritability, flu-like symptoms

Q45. Which antidepressant is commonly used in elderly patients when avoiding anticholinergic effects is a priority?

• Amitriptyline
• Paroxetine
• Sertraline
• Imipramine

Correct Answer: Sertraline

Q46. For pharmacovigilance, which adverse effect related to SSRIs should pharmacists counsel patients to report promptly?

• New or worsening suicidal thoughts, agitation, or severe mood change
• Minor headaches resolving in hours
• Temporary mild dry mouth
• Reduced appetite only

Correct Answer: New or worsening suicidal thoughts, agitation, or severe mood change

Q47. Which antidepressant is most appropriate when a patient’s depression is accompanied by significant neuropathic pain?

• Fluoxetine
• Duloxetine
• Bupropion
• Phenelzine

Correct Answer: Duloxetine

Q48. Which pharmacologic property explains why fluoxetine has a longer duration of action and less discontinuation syndrome than paroxetine?

• Fluoxetine is a stronger CYP3A4 inducer
• Fluoxetine has an active metabolite (norfluoxetine) with a long half-life
• Fluoxetine is not lipophilic
• Fluoxetine is only renally excreted unchanged

Correct Answer: Fluoxetine has an active metabolite (norfluoxetine) with a long half-life

Q49. Which therapeutic option is evidence-based for seasonal affective disorder (SAD)?

• Daily light therapy (phototherapy)
• High-dose benzodiazepines
• Immediate MAOI therapy only
• Long-term opioid therapy

Correct Answer: Daily light therapy (phototherapy)

Q50. Which management step is recommended when a patient on an SSRI develops mild serotonin syndrome?

• Continue the SSRI and add MAOI
• Stop serotonergic agents, provide supportive care, consider cyproheptadine if needed
• Administer high-dose benzodiazepines only
• Initiate immediate ECT

Correct Answer: Stop serotonergic agents, provide supportive care, consider cyproheptadine if needed

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