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Antidepressants

Reviewing antidepressant use

People should have regular reviews with their doctor after being prescribed a new antidepressant medicine. They should also have review appointments with their doctor when they have been taking antidepressants on a regular basis so that he or she can find out how they are feeling, and also for the opportunity to ask questions and talk through any concerns. It can take a while to find an antidepressant that works as everyone responds differently to them, so keeping in regular touch with the doctor whilst you get used to taking one, and to monitor your progress on an ongoing basis is good practice. You may also be offered a medicines use review by your pharmacist. These reviews concentrate mainly around the use of medicines. People we spoke to who saw their doctor on a regular basis to talk about their medicines and how they were feeling appreciated the opportunity to talk things through, and having somebody to give them advice and support. 
 

Tim’s doctor was very clear about how often he should see her...

Tim’s doctor was very clear about how often he should see her...

Age at interview: 29
Sex: Male
Age at diagnosis: 27
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It was a kind of sense of we’ll start you on this.
 
Right.
 
And see how you go, this was a kind of light dose and she was quite cautious about it and said, you know, I want to see you in two weeks and see how you’re getting on and I want to do this and I felt, because in that segment of time I saw the same person and I felt that she was quite she was quite good she sort of, what I appreciated was that she didn't pretend to know things she didn’t know and it was unreasonable to expect GP’s to be experts in everything, she said look, you know, this isn’t, I don't know, I’m not sure how she phrased it but she didn't try and, she made a conversation about my kind of situation which was appreciated and so she was quite good at kind of saying I want to see you here and I want to see you then.
Doctors should arrange follow up appointments as a matter of course For people starting on antidepressants who are not considered to be at increased risk, the GP should see them after 2 weeks initially, and then at intervals of 2 – 4 weeks in the first 3 months. In our interviews people said the time between follow up appointments varied. Tim valued his doctors clear advice about when he should return to monitor his progress on the antidepressant he had been prescribed. Some people took the initiative to book regular appointments for themselves. Emily arranged monthly appointments to see her GP. I wanted the reassurance that I was doing the right thing, that I should still be on it.’ Andrew’s doctor had left it to him to decide whether to make an appointment. ‘Basically he said come back whenever you want and I’ll be more than happy to see you’. A face to face appointment isn’t always necessary, these days doctors often provide advice and support by phone. Victoria had regular telephone consultations with her GP to monitor her progress. 
 

Lucy Y goes to see her GP when her repeat prescription has...

Lucy Y goes to see her GP when her repeat prescription has...

Age at interview: 23
Sex: Female
Age at diagnosis: 18
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He was very good about repeat prescriptions and things, he’d give me, you know, between three and six months’ supply and say just come back to me when you need a repeat and we’ll check that everything’s okay and that worked quite well. I mean during that time I did move cities twice, I moved from where I lived in University back to where my parents live and again when, when I ran out of repeat prescriptions I found a GP there, who was also very helpful, and yep continued reviewing that with me. 
 

Charlotte sees her doctor regularly every three months, but...

Charlotte sees her doctor regularly every three months, but...

Age at interview: 34
Sex: Female
Age at diagnosis: 20
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I can just phone and get a repeat prescription now but she’s said to me ever since the beginning if I need to talk to her I can just phone her and she’ll phone me back or they told me I can phone the surgery and another GP will talk to me because they’ve got all my history there anyway and probably about every three or four months now I go and see her just for like a general check.
 
Review appointments can provide an opportunity for people to discuss different aspects about their illness and treatment, and can help them to make decisions. Lou used follow up appointments to plan when she might stop taking the antidepressant. Sonia’s medicines were sometimes changed or the dose adjusted when she returned to see her psychiatrist every 6 months. Steve felt it could be helpful if the doctor asked you questions for example, ‘is it affecting your sleeping, is it affecting your eating?’ because it can sometimes be difficult to make connections between changes in the way you feel, and the medicines you are taking. 
 

Melanie sees her doctor regularly to discuss how she is feeling...

Melanie sees her doctor regularly to discuss how she is feeling...

Age at interview: 44
Sex: Female
Age at diagnosis: 43
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And you talked about going for a review then you, do you go to see the GP, how regularly now just to check out how you are?
 
Well I go every month to get my new prescription.
 
So it’s not on a repeat, you actually go?
 
Yeah to get a sick note, every couple of months they go through a questionnaire with me.
 
What’s the questionnaire?
 
It’s sort of asks me how I’m feeling it’s kind of like how many times or how often do you feel hopeless, so it’s like every day, every other day, once a week or never.
 
How helpful is that, something like that for you to fill out one of those questionnaires?
 
I would like to see that I’m improving but I haven’t seen that I am at the moment. I’m constant, I’m consistent with my replies and maybe I’ll be due to do it the next time in like three weeks and I would hope then that I am feeling a little bit more hopeful about things.
 
You’ve been on the antidepressants for about four months now?
 
Yeah.
 
And has it remained at the same dose, has the doctor suggested increasing it or changing it at all in any way?
 
Well I think the last time he had suggested that we increased it because, you know, I didn’t really, he obviously didn’t feel like we were getting anywhere with my symptoms changing but I said I didn’t want to.
 
What was your reasons, feelings about that?
 
Obviously I’m worried that I might get more side effects from the medication if I increase it and I don’t feel I want to be that dependent on the medication.
 
So you stayed on the same dose?
 
Yeah.
 
And is that something that you might think about again if things don’t improve or are you really sure that you don’t want to do that?
 
Because it was my decision this time I suppose if I go back for a review and the doctor impresses to me that we really need to change your dosage then I would accept his guidance on that.
 
It sounds like you also like to be in control and help make those decisions yourself?
 
Yeah. So I’m hoping if I can stay on the smaller dosage and get some benefit from the counselling rather than keep increasing my medication.

People sometimes had difficulties arranging appointments to see their doctor and some felt that there was not enough time during a regular ten minute appointment to have a full discussion. 
 

Stephen tries to get the last appointment...

Stephen tries to get the last appointment...

Age at interview: 48
Sex: Male
Age at diagnosis: 44
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You say that you go back to your GP for regular reviews, do you do you go every month or how often do you do that?
 
Every two months at the moment so I’m due in about three weeks.
 
So you get a repeat prescription for the six weeks?
 
Yes.
 
Or eight weeks and then go back to get the new one and talk about?
 
Yes.
 
Right. And so is that a good opportunity to talk about anything that you need to in terms of your, you know, how you’re feeling as well about the medication?
 
I tend to try and get the last possible appointment because that way you can actually have the longer chat if need be. and the doctor ‘s very good at that, I think they understand that sometimes the ten minutes allowed for the appointment isn’t long enough so I do tend to aim for the 6 ‘o’ clock one if possible.
 
So it doesn’t matter if you overrun a bit?
 
Well she might mind the fact that I’m keeping her late, I don’t know but I think it’s better for me that we’re not rushing things.
 
Sometimes the way the GP practice is organised can make it difficult to see the same doctor each time. Several people stressed the importance of having a relationship with a GP who knows you so that he or she is more able to assess how things are going. Melanie found it frustrating to have to keep telling her story to different doctors, and wanted the doctor to be able to observe her progress by knowing her better. Lou felt strongly that a review appointment should be not just be about medicine use, and that doctors should regularly discuss the possibility of alternative treatments such as counselling or therapy with patients. Stuart would like doctors to offer lifestyle advice and give more information and support about other ways to alleviate depression. 
 

Melanie found follow up appointments impersonal because...

Melanie found follow up appointments impersonal because...

Age at interview: 44
Sex: Female
Age at diagnosis: 43
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When you’re not seeing the same person they can’t tell whether there’s any change in you or, you know, if I was seeing the same doctor and they would say ‘Oh well you look like you’re having a good day today,’ or ‘How are you feeling you look a bit chirpier,’ or ‘Oh look you’ve bothered to put some make up on today’. But you see, when you see a different doctor they don’t see that so it would have probably been beneficial to see the same person so they could have ,maybe said to me, you know, ‘Well you seem to be pulling yourself together’ and ‘How have you managed to do that?’.
 
I think it would help to see the same person. And I know they could see hundreds of people in that period so they mightn’t necessarily remember you but I would hope that if they did they would be able to see whether you were worse than when you’d previously been in or whether you were a little bit improved.
 
Do they tend to, you know, have notes that they look at before you’ve been in the room or do you find that they just kind of on the spot and asking you questions?
 
They do have your records on the computer, I mean gone are the days of written doctors notes now it’s all on the computer but again it depends, you know, if the previous doctors typed anything up.
 
Whether it’s just a note of what you’re taking or more about how you’re feeling that sort of thing.
 
Yeah so, you know, I suppose that’s why they sit there and say well, you know, how are you feeling or do you think you’ve improved or. And I kind of want them to tell me if they think I’ve improved or moved on, it is very impersonal. I mean I appreciate the setup of GP’s surgeries and stuff like that and resources and, but you kind of want a little bit more when you are poorly or when, you know the fact that I feel like I’m waiting that long to see the counsellor and God forbid I was of a lesser constitution I could have thrown myself off the bridge by now because I could have thought nobody wants to help me.
 

The doctor was happy to issue a repeat prescription...

The doctor was happy to issue a repeat prescription...

Age at interview: 50
Sex: Male
Age at diagnosis: 49
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I haven’t seen my GP for a couple of months… well I’ve seen my GP about my migraine actually but not specifically about this. basically he said come back whenever you want and I’ll be more than happy to see you, if you get on with it okay, you feel you’re getting on with it okay, do that but at some point in the future there will have to be a review.
 
So you are on a repeat prescription?
 
I’m on a repeat prescription now so they know that I’m taking tablets, I haven’t gone back and said I think it’s time for that review.
 
Just slightly wary about that it sounds like.
 
I am a bit but I think, whilst they’re happy to keep with the repeat prescription without seeing me I’m happy to just stay on the tablets but I think after the summer I will go back and have an appointment just to talk about how I’m doing just so he knows and that they don’t forget me. I don’t think they have forgotten me.
 
I suppose that’s an opportunity to talk about your concerns about how long to be on them for?
 
Yes absolutely and he said a lot of people who go on come off too quickly and then they end up going back on again. So he said just see how you get on and of course and in due course, I don’t think it’s the case but I do think that like getting them on repeat prescription, because in my mind I’m thinking he’s conscious of who I am at least and maybe thinking oh yes it’s that guy who came in.
 

Lou said it’s very easy for doctors to keep doling out...

Lou said it’s very easy for doctors to keep doling out...

Age at interview: 39
Sex: Female
Age at diagnosis: 22
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I would ask people to keep revisiting that with people they’re prescribing to and really try and motivate people to have some kind of talking therapy as well because I think otherwise you are just treating the symptoms and not helping people really move on, you know so just push that message really because it is very easy to dole out medication to people who are willing to, very happily willing to take them. But you know I think people should have regular reviews and that should include you know, where they are with talking therapies. A little bit of me would say that, you know, should consider refusing to prescribe people unless they’re open to that, it’s a bit harsh but you know I do think it would be criminal just to give someone antidepressants for ten years, medicating just, you know for ten years, twenty years and then not try anything other than medication.
 
Not everyone had a clear idea about when or whether they should make a follow up appointment with the doctor. Some said their doctor had left it up to them, and that they felt they had been left to ‘get on with things’ without sufficient support. Sharon felt annoyed when she phoned to ask her doctor about her prescription and had been given advice by a receptionist. 
 

When the first month’s supply of citalopram ran out Steve...

When the first month’s supply of citalopram ran out Steve...

Age at interview: 31
Sex: Male
Age at diagnosis: 30
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I called him because I wasn’t, he only gave me a month’s prescription to start off with and then so I took the month and then I actually didn’t take them for a week and then I thought, oh sorry then I had an appointment to talk to the counsellor and I said to her, I said ‘Look I’ve ran out of these,’ he didn’t call me or do anything in the meantime which that’s interesting considering they know you’re meant to be on them for six months. You very much have to do it yourself otherwise it doesn’t happen yes that’s very true. But yes so she said to me, I said ‘Look I’ve ran out of them’ she said, ‘Are you on any medication?’ I said ‘I was but kind of my course ran out about a month ago.’ She said ‘What are you taking?’ I said ‘citalopram,’ she said ‘No you’re meant to be on that for six months,’ I was like ‘Oh, oh I’d better go and get some more then.’ so then I called my doctor, my doctor called me back rather than having to have an appointment and I said ‘Look I don’t understand, my therapist just, well not my therapist, my counsellor has just said that I should be on these for six months,’ and he said ‘Oh yes you should be on, you should be on a repeat prescription,’ and then he said ‘It would be ready for you later on today if you want to come and pick it up,’ so I never even saw him I just went in and picked it up.
 
Often people who are taking an antidepressant on an ongoing basis are issued with a regular repeat prescription to collect from the surgery or pharmacy. Some said they rarely saw the doctor for a review and it could feel as though their progress was not being monitored. Some said they only went to see their doctor if they had a specific question to ask or an issue they wanted to discuss, for example if they felt the antidepressant had lost it effectiveness. Sometimes the doctor reviewed people’s use of an antidepressant when they went to see him or her about another matter, as well as checking to make sure that other prescribed medicines could be safely combined with the antidepressant they were taking. Jenny has been on a number of medicines for acute asthma and other related health conditions and now checks things for herself using the British National Formulary (BNF). People who were under the care of other specialists for other conditions stressed the importance for their all their medicines to be reviewed together at the same time, (see ‘Managing other illnesses’). 
 

Jenny takes numerous medicines for other health conditions...

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Jenny takes numerous medicines for other health conditions...

Age at interview: 36
Sex: Female
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The main thing I have noticed in terms of the anti-depressants is that when you have been on them a long time, had them on “repeat prescription”, GP’s tend to forget about them when prescribing other acute medications. There can be some interactions with other medications. But these are usually picked up by the pharmacist dispensing the drugs, if the doctor has missed it.
 
For me the only real issue I’ve had was when I started my current anti-depressant, it upset my Warfarin levels, blood thinning medication, but after a few weeks, and a few extra blood tests we got things levelled out again.
 
I have to admit to being different from most people. Due to the large number of drugs I take, I have my own copy of the BNF publication that doctors use, so that I can check up on any interactions etc that might occur when I have to start a new medication. I get a new BNF annually from my GP.
 
Sometimes the doctor will want to carry out more frequent reviews, for example where somebody has been having suicidal thoughts or has previously taken an overdose. Sonia and Thomas were only allowed a limited supply of their medicines at a time, and the doctor would not re-issue a further prescription without seeing them regularly. Whilst Sonia found this reassuring, Thomas felt resentful at being forced to go each week. He found it difficult to arrange so much time away from work, especially as it he did not want to reveal details about his mental health status to his employer. 
 

Sonia’s doctor kept a close eye on her and only prescribed...

Sonia’s doctor kept a close eye on her and only prescribed...

Age at interview: 31
Sex: Female
Age at diagnosis: 17
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My GP then actually was brilliant in terms of, because I was only being given a weekly, I was on weekly prescriptions because my psychiatrist, because obviously she knew I was suicidal and because I’d tried to kill myself she didn’t trust me with, which is quite common they don’t often trust you with more than…
 
Had that being an overdose type of thing?
 
Yeah, they, they often don’t trust you with more than a week’s worth of medication and my GP was brilliant because she would leave out repeat prescriptions but she would never let a month go by without seeing me, so on the last one she would always leave a little note saying please make an appointment for your next prescription is due which was great because it was just someone to kind of keep in touch with and kind of someone saying ‘are you okay’, you know, ‘is everything going okay?’. Because obviously your psychiatrist is there but you don’t necessarily see them all that often. 
 

Thomas found it awkward to have to keep going back to see the GP...

Thomas found it awkward to have to keep going back to see the GP...

Age at interview: 34
Sex: Male
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My GP would use it as a mechanism to get me to go back and see her, and see me in the surgery and that’s what they were doing recently with me, when I was coming off the sleeping pills. They would only prescribe me mirtazapine, the antidepressant that I was on and the sleeping pills one week at a time. They would force me to come back at one week intervals.
 
And what effect did that have on you? Did you kind of resent that?
 
I really resented it, because of work problems I was having. I was taking so much time off with these medical appointments and everyone else in the office was like, well they could see me coming in at 11 o’clock in the morning. It was like, it was because I’d been queuing since 8.30 to see my GP but it still looks bad. And trying to kind of explain to people, although I didn’t explain it at all. It was a medical thing.
 
So that made it quite difficult kind of not being able to provide any kind of cogent explanation as to what…?
 
No and I would always have to give kind of, get into quite convoluted stories really, to try and explain why I was coming into the office late.
 
(See also ‘Stopping taking antidepressants’ and ‘Changing antidepressants’).

Last reviewed June 2016.
​Last updated June 2016.
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