Sorry came in late on this one. If they are bad when they first
present I will review at 2 weeks. If not too bad then first review I
will leave for 4 weeks, but also depends on the work situation. I
generally persuade them they may need a month or so off, but if they
are reluctant to do this I will see them at 2 weeks, and generally
when they have been seen at 2 weeks they agree that works can actually
do without them and that they are feeling a lot better although not
100%. I tned to stick with Citalopram more than anything as I have
used it a lot and got excellent results, titrating up to 40mgs SLOWLY
over 2 months if required (I have had patients with the jitters by
foolishly me trying to increase too soon). I always warn them about
possible GI side effects and that they will go if they persevere.
At 1 month I generally find that some are doing very well. These I
give a script for 2 months and then tell them I want a telephone
review with them. I tell all patients at the onset that I will review
them 2 monthly by telephone when they are improving. I also warn them
that they will continue on the ADs for around 6 months, BUT if this
takes them into the autumn or winter, then I will keep them on them
until the spring. I NEVER stop ads beyond August - to many 'bounce
back with depression. The non-repsonders at 4 weeks I see 2 weekly and
titrate up by 10mgs each 2 weeks. Usually works well at the higher
dose.
As has been mentioned I NEVER put ADs on repeat and tell all patients
that they are likely to get better. Increasingly I consider that the
first review at 2 weeks does little apart from getting a feel that
they may respond to Citalopram and I tyr and encourage them that if we
are seeing any positive signs then we need to leave things a further
2-4 weeks. Despite what the books may say I do think SSRIs -
especially Citalopram are effective in reactive depression and grief
reactions. I am not a fan of counselling and often work hard to
convince patients that I believe I can get them feeling a lot better
on a 6 month course of ADs.
Hope this helps.
Paul
On 26/04/07, Dr Skinner <[log in to unmask]> wrote:
> I need the panel's advice, please. What is current thinking on review
> periods for depressed patients on medication (in the main of course, SSRIs)?
> Clearly the answer to this might include the phrase "it depends on the
> individual circumstances of the patient" but I am thinking of the stable
> patient who perhaps has shown a good response to the medication and is
> perhaps 2-4 months into the treatment - or perhaps someone who has been
> taking an SSRI for many months or even years and is keen to continue.
> 2-monthly scripts and reviews? 3-monthly? 6-monthly? Does anyone have a
> "norm" for this, or even a practice policy? No need for long detailed
> answers - I just want to get a feel for what others do.
>
>
> Paul Skinner
>
--
Best Wishes
Paul Bromley
www.floridaholidayvilla.biz
Superb Villa in Orlando with own pool - Free Internet & International
Phonecalls.
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