1. Why this matters for MRCGP

PTSD is high-yield for MRCGP because it tests more than symptom recognition: the key marks are in asking about trauma safely, spotting risk, knowing when to refer, and avoiding unsafe prescribing. In AKT, expect thresholds: symptoms after trauma, TSQ timing/score, one-month follow-up, under 18 drug treatment, same-day suicide risk referral, and SSRI/SNRI monitoring. In SCA, the challenge is often a patient presenting with sleep, anger, physical symptoms, shame, avoidance, or reluctance to talk about trauma. The prescribing risk is real: antidepressants may be used in adults, but not for under 18 PTSD, and venlafaxine/SSRI safety monitoring matters.

2. GP Bottom Line

Suspect PTSD after traumatic exposure plus re-experiencing — flashbacks, intrusive images/thoughts or nightmares — with avoidance, hyperarousal, emotional numbing, negative thoughts or functional impairment. Urgency changes if there is high suicide risk, inability to stay safe, safeguarding concern, severe distress/impairment, or urgent physical health concern. The GP role is initial assessment, risk assessment, coordination, active monitoring where appropriate, referral, and safe adult prescribing where supported. Biggest trap: do not offer drug treatment for PTSD in under-18s, do not use psychologically focused debriefing, and do not start specialist antipsychotic treatment in GP.

3. 60 Second Exam Snapshot

• PTSD can start in the first month after trauma, but symptoms may be delayed by months or years.
• Re-experiencing is the most characteristic symptom.
• Trauma may be directly experienced, witnessed, learned about when a traumatic event has occurred to a close family member or close friend, or involve repeated/extreme exposure to aversive details through work.
• Trauma Screening-Questionnaire (TSQ): use three weeks or more after trauma; six or more positive responses means risk of PTSD and referral for further assessment.
• For subclinical/subthreshold PTSD symptoms, consider active monitoring/watchful waiting and arrange regular follow-up. If symptoms are reported within the first month after trauma, arrange follow-up within one month.
• Adults with clinically important symptoms: refer for specialist trauma-focused psychological therapy and/or drug treatment.
• Under-18s: specialist referral if clinically important symptoms persist more than one month; do not offer PTSD drug treatment.

4. Recognition and Diagnosis

Think PTSD when there has been a traumatic event and the patient reports:

• Re-experiencing: flashbacks, intrusive thoughts/images, nightmares.
• Avoidance: avoiding people, places, memories or thoughts linked to the trauma.
• Hyperarousal: hypervigilance, irritability, anger, exaggerated startle, insomnia or poor concentration.
• Negative mood/thinking: guilt, shame, negative beliefs, feeling diminished or worthless.
• Emotional numbing, dissociation, emotional dysregulation or relationship problems.

Children may present differently: trauma-related dreams that become monster nightmares, trauma re-enactment in play, sleep problems, secondary enuresis, separation anxiety, loss of interest, belief they will not grow up, tummy aches or headaches.

Ask about trauma in patients repeatedly presenting with unexplained physical symptoms, depression, anxiety disorders or substance misuse. Some patients are anxious, ashamed or reluctant to discuss trauma, so give examples of traumatic events. Important differentials include depression, generalised anxiety disorder, panic disorder, specific phobias, adjustment disorder, dissociative disorders and psychosis. PTSD may also be comorbid with depression and anxiety. Diagnosis is usually confirmed by a mental health specialist; in children it is confirmed by referral to a specialist mental health service.

5. AKT Essentials: What Changes the Answer

Diagnosis / recognition

• PTSD symptoms are described as persisting for at least one month after trauma.
• Delayed expression can occur months or years later.
• Complex PTSD occurs after extremely threatening or horrific, often prolonged/repetitive trauma from which escape is difficult or impossible, with core PTSD plus affect regulation problems, negative self-beliefs and relationship difficulties.

Investigation / screening

• TSQ has 10 questions on re-experiencing and arousal.
• Use TSQ three weeks or more after exposure.
• Six or more positive responses → risk of PTSD → refer for further assessment.
• Use the actual TSQ form; the key revision facts are timing and threshold.

Management / next best step

• For subclinical/subthreshold PTSD symptoms, consider active monitoring/watchful waiting and arrange regular follow-up. If symptoms are reported within the first month after trauma, arrange follow-up within one month.
• Clinically important symptoms = at least moderate functional impairment and/or above clinical threshold on a validated scale.
• Adult clinically important symptoms → specialist referral.
• Children and young people aged 18 years and under with clinically important PTSD symptoms persisting for more than one month should be referred to a specialist mental health service.
• Child/young person trauma within last month → clinical judgement: active monitoring or referral; seek specialist advice if doubt.
• If PTSD and depression coexist, usually treat PTSD first because depression often improves with successful PTSD treatment. Treat depression first if it is severe enough to make PTSD psychological treatment difficult, or if there is risk of harm to self or others.

Referral / urgency

• High suicide risk → same-day referral to crisis resolution and home treatment team.
• Life at risk, serious self-injury/overdose, or cannot keep self/others safe → 999 or A&E.
• Urgent mental health help but not immediate life risk → 111 mental health option or urgent GP appointment.

Medicines / safety

• Adults: consider venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline, if drug treatment is preferred, psychological therapy is declined, or referral is significantly delayed.
• Only sertraline and paroxetine are licensed in the UK for PTSD.
• Venlafaxine is not licensed for PTSD.
• Under-18s: do not offer PTSD drug treatment.
• Antipsychotics such as risperidone are specialist-started and specialist-reviewed.

Follow-up / monitoring

• Adult SSRI or serotonin and noradrenaline reuptake inhibitor (SNRI): review every 2–4 weeks for the first 3 months, then every 3 months.
• Under 30 starting SSRI/SNRI: review within 1 week, then monitor suicide/self-harm risk weekly for the first month.
• Venlafaxine: screen for high blood pressure, control pre-existing hypertension, and review BP after starting and after dose increases.

6. SCA Consultation Essentials

Likely SCA task: “I cannot sleep since the accident,” “I keep seeing it,” “I feel on edge,” “I am angry all the time,” “I have unexplained stomach pains,” or a parent worried about a child after trauma.

Key data to gather

• What happened: direct trauma, witnessed trauma, learning that a traumatic event occurred to a close family member or close friend, or repeated/extreme exposure to aversive details through work.
• Symptoms: re-experiencing, avoidance, hyperarousal, mood/thinking change, dissociation, emotional numbing.
• Function: work/school, relationships, social life, quality of life.
• Severity: mild, moderate or severe distress/impairment.
• Risk: suicide, self-harm, harm to others, safeguarding, physical health concerns.
• Comorbidity: depression, anxiety, gambling-related harms, alcohol or substance misuse.
• Social needs: employment, accommodation, family impact.
• For children and young people, where developmentally appropriate, ask them directly about PTSD symptoms and do not rely solely on the parent or carer.

Communication pivots

• Name the condition without forcing disclosure: “These symptoms can happen after trauma, and you do not have to tell me every detail today.”
• Explain treatability, but do not overpromise.
• Offer referral and access options; explain that trauma-focused psychological treatments are specialist-delivered.
• For adults considering medication, explain delayed benefit, early side effects, withdrawal risk and review plan.
• For children, explain that specialist assessment is needed and drug treatment for PTSD is not offered.
• Do not exclude people with PTSD from treatment solely because of comorbid drug or alcohol misuse.

7. Red Flags / Escalation / Referral

Immediate emergency action Call 999 or go to A&E if someone’s life is at risk, they have seriously injured themselves or taken an overdose, or they cannot keep themselves or someone else safe.

Same-day mental health referral High suicide risk → same-day referral to crisis resolution and home treatment team.

Urgent mental health advice Use 111 online or call 111 and select the mental health option, or request an urgent GP appointment if urgent help is needed.

Specialist PTSD referral

• Adults with clinically important PTSD symptoms: refer for trauma-focused psychological therapy and/or drug treatment.
• Children and young people aged 18 or under: refer if clinically important symptoms persist for more than one month.
• Armed forces veterans with service-related PTSD can be referred more rapidly than civilians under the veterans’ priority scheme (e.g. Op COURAGE).
• Follow local referral policy for specialist mental health services.

Safeguarding Assess children and vulnerable adults for safeguarding concerns and follow local safeguarding procedures.

Risk management / safety plan If assessment identifies a significant risk of harm to self or others, establish or coordinate a risk management and safety plan, involving family members or carers if appropriate.

8. What the GP Should Do Today

Assess

• Ask about trauma exposure and PTSD symptom clusters.
• Assess function, distress, suicide/self-harm risk, harm to others, physical health concerns and safeguarding.
• Ask about comorbid mental health problems, alcohol/substance misuse and social needs.

Screen if useful

• Consider TSQ if at least three weeks after trauma.
• Six or more positive responses → refer for further assessment.

Decide urgency

• Emergency physical/mental health assessment if needed.
• Same-day crisis referral if high suicide risk.
• 999/A&E if life risk or cannot keep safe.
• If assessment identifies a significant risk of harm to self or others, establish or coordinate a risk management and safety plan, involving family members or carers if appropriate.

Manage initial pathway

• For subclinical/subthreshold PTSD symptoms, consider active monitoring/watchful waiting and arrange regular follow-up. If symptoms are reported within the first month after trauma, arrange follow-up within one month.
• Clinically important symptoms → specialist referral.
• If PTSD and depression coexist, usually treat PTSD first because depression often improves with successful PTSD treatment. Treat depression first if it is severe enough to make PTSD psychological treatment difficult, or if there is risk of harm to self or others.
• Do not exclude people with PTSD from treatment solely because of comorbid drug or alcohol misuse.

Advise

• Explain common trauma reactions, PTSD symptoms, treatability and treatment options.
• Consider impact on family members and whether they need assessment/support.
• Adults in England may self-refer to NHS Talking Therapies where eligible.
• Under-18s can access children and young people’s mental health services through professionals such as GP, teacher, school nurse or social worker; some services allow self-referral.

Prescribe only where supported

• Adult antidepressant treatment may be considered in specified circumstances.
• Do not offer PTSD drug treatment to under-18s.
• Do not offer psychologically focused debriefing.

9. Practical Use in GP: How to Apply This Topic

Before referral or prescribing

• Check severity and function.
• Check risk to self/others and safeguarding.
• Check comorbid depression, anxiety, alcohol/substance misuse and physical health concerns.
• Check whether symptoms are subthreshold or clinically important.
• Check whether trauma was within the last month.

Starting / advising

• Active monitoring means regular monitoring without current clinical intervention. For subclinical/subthreshold PTSD symptoms, consider active monitoring/watchful waiting and arrange regular follow-up. If symptoms are reported within the first month after trauma, arrange follow-up within one month.
• Adult medication discussion should include psychological therapy options first where appropriate, likely slow benefit, adverse effects, withdrawal symptoms and review arrangements.
• For adults preferring medication, declining psychological therapy, or facing significant referral delay, consider venlafaxine or an SSRI.

Patient instructions

• Do not stop PTSD medicine unless told by a doctor.

Review / monitoring

• Adult SSRI/SNRI: review effect and adverse effects every 2–4 weeks for 3 months, then every 3 months.
• Under 30: review within 1 week after first SSRI/SNRI prescription and monitor suicide/self-harm risk weekly for the first month.
• Venlafaxine: check and monitor blood pressure as above.
• Where PTSD management is shared between primary and secondary care, agree in writing who is responsible for monitoring, involving the person and family/carers if appropriate.

Escalate / stop / change if

• High suicide risk, inability to stay safe, safeguarding concern, serious adverse effect, or emergency physical concern.
• Do not abruptly stop antidepressants except in exceptional medical circumstances.

Medicine details

• For medicine choices, doses or withdrawal plans not covered here, use BNF/local prescribing guidance.

10. Medicines, Investigations and Intervention Safety

Screening: Trauma Screening-Questionnaire

• Use: primary-care aid to identify likely PTSD.
• Timing: three weeks or more after exposure.
• Interpretation: six or more positives → risk of PTSD → refer for structured assessment.
• Use the actual TSQ form; remember timing and threshold.

Psychological therapies

• Specialist options include trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR).
• GP role: explain and refer; not to deliver specialist trauma therapy unless appropriately trained and within service role.
• Psychologically focused debriefing: do not offer for prevention or treatment.

SSRIs

• Adult PTSD: sertraline or paroxetine are licensed UK options.
• Sertraline: start 25 mg once daily for 1 week, then 50 mg once daily; increase in 50 mg steps at intervals of at least 1 week if required/tolerated; maximum 200 mg/day.
• Paroxetine: 20 mg daily in the morning; maximum 50 mg/day in adults, 40 mg/day in elderly people.
• Paroxetine has higher discontinuation/withdrawal risk than other SSRIs.

Key SSRI safety

• Avoid in manic phase, with monoamine oxidase inhibitors or recent monoamine oxidase inhibitor use, pimozide, uncontrolled epilepsy or new onset seizures.
• Use caution with cardiac disease, epilepsy, bleeding history, diabetes, mania history and susceptibility to angle-closure glaucoma.
• Monitor for hyponatraemia symptoms such as dizziness, lethargy, nausea, confusion, cramps and seizures.
• Advise about drowsiness and driving/skilled tasks impairment.
• Before starting an SSRI or venlafaxine, check interacting medicines. High-yield source-supported risks include bleeding with NSAIDs/aspirin and anticoagulants such as warfarin/coumarins or dabigatran, and serotonin syndrome risk with other serotonergic medicines such as tramadol, triptans or St John’s Wort.

Venlafaxine

• Adult PTSD: may be considered, but PTSD use is off-label.
• Venlafaxine modified-release: 75 mg once daily, increased if needed up to 225 mg once daily at intervals of at least 2 weeks.
• Venlafaxine: do not use with uncontrolled hypertension or monoamine oxidase inhibitor/recent monoamine oxidase inhibitor use. Conditions associated with high risk of cardiac arrhythmia are a major prescribing caution/red flag — check BNF/local prescribing guidance before prescribing.
• Screen for high BP; control pre-existing hypertension; review BP after initiation and dose increases.
• Breastfeeding: avoid.
• Pregnancy: avoid unless potential benefit outweighs risk.

Antipsychotics

• Risperidone may be considered for disabling symptoms/behaviours after non-response to other treatments, but only as specialist-started and regularly specialist-reviewed treatment.

Sleep

• Sleep hygiene is supported.
• Consider a hypnotic for short-term use for sleep problems.
• For medicine choices, doses or withdrawal plans not covered here, use BNF/local prescribing guidance.

Adult prevention prescribing trap

• Do not offer drug treatments, including benzodiazepines, to prevent PTSD in adults. This is separate from short-term symptomatic treatment of established sleep problems, where sleep hygiene and consideration of a short-term hypnotic are supported.

Pregnancy and breastfeeding

• SSRIs/SNRIs may slightly increase postpartum haemorrhage risk when used in the month before delivery.
• Sertraline and paroxetine are stated as SSRIs of choice in breastfeeding; infants should be monitored for drowsiness, poor feeding, weight gain, gastrointestinal disturbance, irritability and restlessness.
• Venlafaxine is present in milk — avoid.

Shared-care monitoring

• Where PTSD management is shared between primary and secondary care, agree in writing who is responsible for monitoring, involving the person and family/carers if appropriate.

Self-harm and safer prescribing

• If self-harm risk is relevant, consider medicine toxicity in overdose, alcohol/recreational drug use, access to medicines, multiple prescribers, limiting quantities and medicines review.
• Do not use risk tools/scales to predict future suicide or repetition of self-harm.

11. How to Explain It to the Patient

“PTSD can happen after very frightening or distressing events, and symptoms can appear soon afterwards or much later.”

“The symptoms you describe — especially the flashbacks and feeling constantly on edge — fit with trauma-related symptoms, but we also need to check your safety and how this is affecting daily life.”

“You do not have to tell me every detail of what happened today. I do need to understand enough to help you safely.”

“PTSD is treatable. The main treatments are specialist trauma-focused talking therapies, and sometimes medicines are used in adults.”

“If you feel you might harm yourself, cannot keep yourself safe, or someone’s life is at risk, that needs urgent help straight away.”

“If we start an antidepressant, we will review you closely, especially early on, and you should not stop it suddenly without medical advice.”

12. When the Plan Changes

• If… the patient is at high risk of suicide.
  • Why this changes the plan: This is not routine PTSD follow-up.
  • What the GP does now: Same-day referral to the crisis resolution and home treatment team.
• If… assessment identifies a significant risk of harm to self or others.
  • Why this changes the plan: A risk management and safety plan is needed as part of initial treatment planning.
  • What the GP does now: Establish or coordinate a risk management and safety plan, involving family members or carers if appropriate.
• If… symptoms are subclinical/subthreshold.
  • Why this changes the plan: Active monitoring is supported.
  • What the GP does now: Consider active monitoring/watchful waiting and arrange regular follow-up. If symptoms are reported within the first month after trauma, arrange follow-up within one month.
• If… an adult has clinically important PTSD symptoms.
  • Why this changes the plan: Specialist trauma-focused therapy and/or drug treatment is indicated.
  • What the GP does now: Refer to specialist mental health services and assess safety while awaiting referral.
• If… the patient is under 18.
  • Why this changes the plan: Drug treatment for PTSD is not offered; diagnosis/treatment is specialist-led.
  • What the GP does now: Refer if clinically important symptoms persist more than one month; if within one month, use clinical judgement and seek specialist advice if unsure.
• If… PTSD and depression coexist.
  • Why this changes the plan: Treatment sequencing matters.
  • What the GP does now: Usually treat PTSD first because depression often improves with successful PTSD treatment. Treat depression first if it is severe enough to make PTSD psychological treatment difficult, or if there is risk of harm to self or others.
• If… the adult wants medication or declines psychological therapy, or referral is significantly delayed.
  • Why this changes the plan: Adult antidepressant treatment may be considered.
  • What the GP does now: Discuss SSRI/SNRI options, adverse effects, withdrawal and monitoring.
• If… venlafaxine is being considered.
  • Why this changes the plan: It is off-label for PTSD and has BP/cardiac safety issues.
  • What the GP does now: Check BP, control hypertension first, monitor BP after initiation/dose increases, and treat conditions associated with high risk of cardiac arrhythmia as a major prescribing caution/red flag.

13. Common AKT / SCA Traps

• Missing PTSD because the presentation is physical symptoms, sleep problems, anger, depression or substance misuse.
• Forgetting symptoms may be delayed by months or years.
• Using TSQ too early or forgetting the six-positive-response threshold.
• Failing to arrange active monitoring and regular follow-up for subclinical/subthreshold symptoms, especially when symptoms are reported within the first month after trauma.
• Forgetting that if PTSD and depression coexist, PTSD is usually treated first, unless depression is severe enough to make PTSD psychological treatment difficult or there is risk of harm.
• Excluding people from PTSD treatment solely because of comorbid drug or alcohol misuse.
• Offering drug treatments, including benzodiazepines, to prevent PTSD in adults.
• Offering psychologically focused debriefing.
• Offering PTSD drug treatment to under-18s.
• Starting risperidone in primary care rather than recognising specialist initiation/review.
• Forgetting under-30 SSRI/SNRI early suicide/self-harm monitoring.

14. Common Exam Angles

• Angle: Adult after road traffic accident with nightmares and avoidance.
  • Hidden challenge: Is this subthreshold, clinically important, or high risk?
  • What the candidate must not miss: Function, risk, timing since trauma, and referral/active monitoring decision.
• Angle: Veteran with service-related PTSD symptoms.
  • Hidden challenge: Referral route/timing may differ.
  • What the candidate must not miss: Veterans with service-related PTSD can be referred more rapidly under the veterans’ priority scheme.
• Angle: Teenager re-enacting trauma through play or refusing to sleep alone.
  • Hidden challenge: Child presentation differs from adult presentation.
  • What the candidate must not miss: Direct questioning where developmentally appropriate and no PTSD drug treatment under 18.
• Angle: Adult requesting tablets while waiting for therapy.
  • Hidden challenge: Safe adult prescribing and review.
  • What the candidate must not miss: Sertraline/paroxetine licensing, venlafaxine off-label status, adverse effects, withdrawal, and early monitoring.

15. 90 Second Audio Summary Script

Post-traumatic stress disorder in primary care is about recognition, risk and referral. Suspect it after a major traumatic event when the patient has re-experiencing symptoms such as flashbacks, intrusive images or nightmares. Re-experiencing is the key anchor, but also ask about avoidance, hyperarousal, emotional numbing, negative thoughts, dissociation, relationship problems and functional impairment.

Do not forget delayed presentations: symptoms can appear months or years after trauma. Also consider PTSD in repeated unexplained physical symptoms, depression, anxiety or substance misuse. Children may show trauma in dreams, play, sleep problems, wetting, loss of interest, or repeated tummy aches and headaches.

The GP role is to assess safety, function, comorbidity, safeguarding, physical health and social needs, then coordinate care. For subclinical or subthreshold symptoms, consider active monitoring and regular follow-up; if symptoms are reported within the first month after trauma, arrange follow-up within one month. Clinically important adult symptoms need specialist referral. In under-18s, refer if clinically important symptoms persist beyond one month; do not offer PTSD drug treatment.

If suicide risk is high, refer same day to crisis services. If life is at risk, there has been serious self-harm or overdose, or the patient cannot keep themselves or others safe, use 999 or A&E. If assessment identifies significant risk of harm to self or others, establish or coordinate a risk management and safety plan.

If PTSD and depression coexist, usually treat PTSD first because depression often improves; treat depression first if it is severe enough to make PTSD psychological treatment difficult, or if there is risk of harm. Do not exclude people from PTSD treatment solely because of comorbid drug or alcohol misuse.

For adults, medication may be considered if drug treatment is preferred, psychological therapy is declined, or referral is significantly delayed. Sertraline and paroxetine are licensed for PTSD; venlafaxine is off-label and needs blood pressure care. Under 30s starting SSRI or SNRI treatment need close early monitoring for suicidal thinking and self-harm.

References

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5. 5th edn. Arlington, VA: American Psychiatric Association.

BMJ Best Practice (2026) Post-traumatic stress disorder. London: BMJ Publishing Group. Available at: https://bestpractice.bmj.com/topics/en-gb/430 (Accessed: 3 May 2026).

Brewin, C.R., Rose, S., Andrews, B., Green, J., Tata, P., McEvedy, C., Turner, S. and Foa, E.B. (2002) ‘Brief screening instrument for post-traumatic stress disorder’, The British Journal of Psychiatry, 181(2), pp. 158–162. doi: 10.1192/bjp.181.2.158.

Joint Formulary Committee (no date) Antidepressant drugs. British National Formulary. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/treatment-summaries/antidepressant-drugs/ (Accessed: 3 May 2026).

Joint Formulary Committee (no date) Paroxetine. British National Formulary. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/drugs/paroxetine/ (Accessed: 3 May 2026).

Joint Formulary Committee (no date) Paroxetine: interactions. British National Formulary. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/interactions/paroxetine/ (Accessed: 3 May 2026).

Joint Formulary Committee (no date) Sertraline. British National Formulary. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/drugs/sertraline/ (Accessed: 3 May 2026).

Joint Formulary Committee (no date) Sertraline: interactions. British National Formulary. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/interactions/sertraline/ (Accessed: 3 May 2026).

Joint Formulary Committee (no date) Venlafaxine. British National Formulary. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/drugs/venlafaxine/ (Accessed: 3 May 2026).

Joint Formulary Committee (no date) Venlafaxine: interactions. British National Formulary. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/interactions/venlafaxine/ (Accessed: 3 May 2026).

Medicines and Healthcare products Regulatory Agency (MHRA) (2014) Antidepressants: suicidal thoughts and behaviour. Drug Safety Update. Available at: https://www.gov.uk/drug-safety-update/antidepressants-suicidal-thoughts-and-behaviour (Accessed: 3 May 2026).

Medicines and Healthcare products Regulatory Agency (MHRA) (2021) SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery. Drug Safety Update, 7 January. Available at: https://www.gov.uk/drug-safety-update/ssri-slash-snri-antidepressant-medicines-small-increased-risk-of-postpartum-haemorrhage-when-used-in-the-month-before-delivery (Accessed: 3 May 2026).

National Health Service (NHS) (2023) Children and young people’s mental health services. Available at: https://www.nhs.uk/mental-health/children-and-young-adults/mental-health-support/mental-health-services/ (Accessed: 3 May 2026).

National Health Service (NHS) (2023) Where to get urgent help for mental health. Available at: https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/ (Accessed: 3 May 2026).

National Health Service (NHS) (2025) Find NHS talking therapies for anxiety and depression. Available at: https://www.nhs.uk/nhs-services/mental-health-services/find-nhs-talking-therapies-for-anxiety-and-depression/ (Accessed: 3 May 2026).

National Health Service (NHS) (2026) PTSD (post-traumatic stress disorder). Available at: https://www.nhs.uk/mental-health/conditions/ptsd-post-traumatic-stress-disorder/ (Accessed: 3 May 2026).

NHS England (no date) NHS Talking Therapies, for anxiety and depression. Available at: https://www.england.nhs.uk/mental-health/adults/nhs-talking-therapies/ (Accessed: 3 May 2026).

National Institute for Health and Care Excellence (NICE) (2018) Post-traumatic stress disorder. NICE guideline NG116. London: NICE. Available at: https://www.nice.org.uk/guidance/ng116 (Accessed: 3 May 2026).

National Institute for Health and Care Excellence (NICE) (2022a) Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults. NICE guideline NG215. London: NICE. Available at: https://www.nice.org.uk/guidance/ng215 (Accessed: 3 May 2026).

National Institute for Health and Care Excellence (NICE) (2022b) Self-harm: assessment, management and preventing recurrence. NICE guideline NG225. London: NICE. Available at: https://www.nice.org.uk/guidance/ng225 (Accessed: 3 May 2026).

Royal College of Psychiatrists (RCPsych) (2021) Post-traumatic stress disorder (PTSD). Available at: https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/post-traumatic-stress-disorder (Accessed: 3 May 2026).

Important Disclaimer

This MedDigest MRCGP Topic Essentials is an independent educational and revision resource, created to support exam preparation only. It is not a clinical guideline, prescribing resource, or a substitute for your own professional judgment.

This content is designed to highlight exam-relevant clinical principles, management pathways, and consultation approaches in a concise format. Any example explanations, consultation wording, scenario angles, or summary scripts are illustrative and should not be used as stand-alone clinical advice.

This resource has not been produced, reviewed, or endorsed by NICE, the Royal College of General Practitioners, or any other official organisation.

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