Antidepressant Medication Review Form

This form is meant to review your antidepressant medications, often prescribed for depression or anxiety. You can complete this after being asked by the practice or if you would like to make changes to your antidepressant prescription.

Your details

Full name *

Date of birth *

Review of your medication

Medication and dose *

How long have you been taking this medication at this dose? *

How regularly are you able to take your medication? *

Please describe if you experience any new or ongoing side effects on the medication *

Do you take any other regular medications for your mental health? *

How well do you feel the medication is helping you with your mood and anxiety? *

Review of your mood

Please complete the questions below, asking how often you have noticed symptoms of low mood over the last 2 weeks

Review of your anxiety levels

Please complete the questions below, asking how often you have noticed symptoms of anxiety over the last 2 weeks

Your prescription going forward

Would you like to make any changes to your medication? *

Yes No

If YES - what do you wish to change and why? *

If no - why do you wish to stay on the medication? *

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Antidepressant Medication Review Form

Antidepressant Medication Review Form

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