Depression Practice Questions PDF

**Depression** **Diagnosis & Clinical Features** 1. **A patient reports feeling fatigued, hopeless, and worthless for the past month. He sleeps excessively, has gained weight, and says he often feels rejected in relationships. Which feature most clearly distinguishes his depression fr...

**Depression** **Diagnosis & Clinical Features** 1. **A patient reports feeling fatigued, hopeless, and worthless for the past month. He sleeps excessively, has gained weight, and says he often feels rejected in relationships. Which feature most clearly distinguishes his depression from melancholic depression?** - A\) Hypersomnia - B\) Fatigue - C\) Anhedonia - D\) Hopelessness **Answer: A) Hypersomnia** *(Atypical depression features hypersomnia, while melancholic depression involves early morning awakening.)* 2. **A psychiatrist is evaluating a patient who describes feeling "numb" and emotionally disconnected. Despite having a stable job and no recent major life events, he expresses feelings of meaninglessness and prolonged sadness lasting over two years. Which diagnosis best fits his symptoms?** - A\) Major Depressive Disorder - B\) Persistent Depressive Disorder (Dysthymia) - C\) Bipolar II Disorder - D\) Adjustment Disorder with Depressed Mood **Answer: B) Persistent Depressive Disorder (Dysthymia)** *(Chronic, low-grade depression lasting \>2 years without full MDD episodes.)* 3. **Which of the following clinical scenarios would rule out a diagnosis of Major Depressive Disorder (MDD)?** - A\) A patient experiencing psychomotor retardation and early morning awakening for the past 3 weeks - B\) A patient with suicidal ideation and severe anhedonia for 2 weeks - C\) A patient with depressive episodes occurring cyclically every year for the past 5 years - D\) A patient with a history of a hypomanic episode last year but currently meeting criteria for MDD **Answer: D) A patient with a history of a hypomanic episode last year but currently meeting criteria for MDD** *(A past hypomanic episode indicates Bipolar II, not unipolar MDD.)* **Epidemiology & Risk Factors** 4. **A 32-year-old woman with no history of psychiatric illness is experiencing severe anhedonia, fatigue, and poor concentration three weeks after giving birth. Which factor increases her risk for postpartum depression?** - A\) First-time pregnancy - B\) Past history of major depression - C\) Breastfeeding exclusively - D\) Age under 35 **Answer: B) Past history of major depression** *(History of depression is the strongest predictor of postpartum depression.)* 5. **Which statement most accurately reflects the epidemiology of Major Depressive Disorder (MDD)?** - A\) Women are twice as likely as men to be diagnosed with MDD - B\) The prevalence of MDD is equal across genders until age 40 - C\) MDD is more common in men, but women attempt suicide more often - D\) Rates of MDD are highest in adolescents and decline after age 25 **Answer: A) Women are twice as likely as men to be diagnosed with MDD** *(True across most age groups.)* 6. **Which financial factor has been shown to have the strongest association with increased depression rates in U.S. adults?** - A\) Total household income below \$50,000 - B\) Inability to afford health insurance - C\) Having less than \$5000 in savings - D\) Experiencing job loss within the past 2 years **Answer: C) Having less than \$5000 in savings** *(Financial insecurity is a major independent risk factor for depression.)* **Treatment & Pharmacology** 7. **A 45-year-old man is diagnosed with Major Depressive Disorder. He reports significant weight gain, lethargy, and rejection sensitivity. Which antidepressant is the best first-line option for his symptom profile?** - A\) Bupropion - B\) Sertraline - C\) Mirtazapine - D\) Fluoxetine **Answer: A) Bupropion** *(Activating and weight-neutral; avoids sedation seen in SSRIs and mirtazapine.)* 8. **Which statement best describes the time course of response to SSRI treatment for MDD?** - A\) Mood improves within 3-5 days of starting treatment - B\) Full therapeutic effects typically take 4-6 weeks - C\) SSRIs must be taken for at least 6 months before benefits appear - D\) Side effects are uncommon within the first 2 weeks of treatment **Answer: B) Full therapeutic effects typically take 4-6 weeks** *(Early changes occur within 1-2 weeks, but full effects take longer.)* 9. **A patient diagnosed with MDD is prescribed an SSRI. Two weeks later, she reports increased restlessness, excessive sweating, and involuntary muscle twitching. What is the most appropriate next step?** - A\) Increase the SSRI dose - B\) Switch to a different SSRI - C\) Discontinue the SSRI and monitor for serotonin syndrome - D\) Add a benzodiazepine to relieve restlessness **Answer: C) Discontinue the SSRI and monitor for serotonin syndrome** *(Symptoms suggest early serotonin toxicity.)* 10. **Which antidepressant is contraindicated in patients with a history of bulimia due to an increased risk of seizures?** - A\) Sertraline - B\) Fluoxetine - C\) Bupropion - D\) Venlafaxine **Answer: C) Bupropion** *(Lowers seizure threshold, particularly in eating disorders.)* **Suicide Risk & Prevention** 11. **Which statement about suicide risk in patients with MDD is most accurate?** - A\) Suicidal thoughts alone predict imminent suicide attempts - B\) Having access to lethal means is a stronger predictor of suicide than intent - C\) Individuals who survive one suicide attempt are unlikely to attempt again - D\) The presence of a suicide note significantly increases risk of a future attempt **Answer: B) Having access to lethal means is a stronger predictor of suicide than intent** *(Immediate access increases risk exponentially.)* 12. **Which patient would be considered at highest risk for imminent suicide?** - A\) A 28-year-old woman with chronic depression and a history of self-harm - B\) A 40-year-old man with MDD, no past attempts, but easy firearm access - C\) A 17-year-old with passive suicidal ideation but no specific plan - D\) A 65-year-old man with worsening depression and a past suicide attempt **Answer: D) A 65-year-old man with worsening depression and a past suicide attempt** *(Older men with past attempts are at highest risk.)* **Complex Conceptual Questions** 13. **A patient with MDD is prescribed an antidepressant. After three months, he experiences new-onset rapid speech, decreased need for sleep, and impulsivity. What is the most likely explanation?** - A\) Side effects of the antidepressant - B\) Incomplete treatment response - C\) Induced manic episode revealing underlying bipolar disorder - D\) Serotonin syndrome **Answer: C) Induced manic episode revealing underlying bipolar disorder** *(Antidepressants can trigger mania in undiagnosed bipolar disorder.)* 14. **Which of the following best explains the mechanism by which ECT effectively treats severe MDD?** - A\) Enhances dopamine release in the prefrontal cortex - B\) Reduces hyperactivity in the amygdala - C\) Induces neuroplasticity via increased BDNF levels - D\) Directly increases serotonin availability **Answer: C) Induces neuroplasticity via increased BDNF levels** *(ECT promotes neurogenesis and plasticity.)*