Psych CASC / OSCE · General adult psychiatry — mood disorders
Explain winter depression, light therapy and autumn prevention — CASC communication station
MRCPsych/FRANZCP-style communication station: explain seasonal pattern MDD, light therapy parameters and side-effects, Can-SAD framing, suicide safety-netting, and anticipatory bupropion XL prevention.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading. You are the psychiatry registrar in outpatient clinic. [4]
Candidate instructions. Explain the diagnosis of winter-pattern major depression in plain language, outline safe morning light therapy, compare light with an SSRI using trial evidence at lay level, discuss autumn preventive bupropion if appropriate, safety-net for worsening mood or elevated mood, and check understanding. The examiner plays the patient. [4]
Candidate scenario
Your patient meets criteria for recurrent major depressive episodes each winter with spring remission. She is currently early in a symptomatic winter. You plan a quality light box (~10,000 lux mornings) and offer fluoxetine 20 mg orally daily as an alternative or combination. For future years you will discuss bupropion XL starting next autumn while well. She fears light boxes are "alternative medicine" and that antidepressants change personality. She has passive death wishes without plan. [1][2][3]
Marking domains
- Empathy, structure, agenda-setting
- Accurate plain-language explanation of seasonal pattern depression (not "just disliking cold weather")
- Correct light therapy instructions (morning, intensity, duration, eyes open, adverse effects)
- Balanced SSRI discussion with delayed benefit and early activation/suicidality safety-net
- Prevention concept with autumn bupropion timing without overselling
- Risk response to passive death wishes
- Teach-back and written plan [1][4]
Reveal assessor key
Open. Name time; ask main worries (legitimacy of light therapy, personality change, next winter). [4]
Explain diagnosis. "You have major depression that reliably returns in winter and lifts in spring — often called seasonal affective disorder. It is a real medical pattern linked partly to shorter daylight, not a character flaw. It can include heavier sleep, carb cravings and low energy." [3][4]
Light therapy. "A tested bright light box about 10,000 lux, used in the morning for roughly 20–30 minutes with eyes open facing the light — not staring into the bulbs — can work as well as an SSRI for many people with winter depression. Benefits may appear within one to two weeks. Side-effects can include headache, eye strain or feeling wired; stop and contact us if mood goes unusually high." [1][3]
SSRI option. "Fluoxetine 20 mg each morning is a standard alternative or add-on. Benefits build over weeks; early nausea can settle. Contact us the same day if suicidal thoughts worsen after starting. Antidepressants are not intoxicating personality erasers, but we review together." [1]
Prevention. "Because winters keep returning, next year we can start a medicine called bupropion XL in autumn before symptoms usually begin, continue through winter, and stop in spring — that prevents episodes for some people. We will check if it is safe for you first." [2]
Risk. Acknowledge passive death wishes; collaboratively safety-plan; means restriction; crisis contacts; early review. [4]
Close. Summarise, teach-back, written light-use sheet, book review. [4]
References
- [1]Lam RW, Levitt AJ, Levitan RD, et al. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder Am J Psychiatry, 2006.PMID 16648320
- [2]Modell JG, Rosenthal NE, Harriett AE, et al. Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL Biol Psychiatry, 2005.PMID 16271314
- [3]Golden RN, Gaynes BN, Ekstrom RD, et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence Am J Psychiatry, 2005.PMID 15800134
- [4]Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391