Antidepressant treatment is best reviewed 2–4 weeks after start (1 week if risk), then more often early on and at wider gaps once stable.
Medication check-ins are not box-ticking. They are where progress, side effects, and life changes get weighed and the plan gets tuned. A clear timetable keeps care steady and lowers the chance of missing early warning signs.
This guide gives a practical schedule, what each visit should include, and the flags that mean you need to bring a date forward. It follows major guidance and keeps language plain for clinic or home use.
How Often Should Antidepressants Be Reviewed: Practical Schedule
Start with a first review at 2–4 weeks. If there is suicide risk or age 18–25, add a contact at 1 week. After improvement and steady dosing, stretch the gap. Any dose change resets the clock for closer follow-up.
| Scenario | When To Review | What To Check |
|---|---|---|
| New start, usual risk | 2–4 weeks | Early response, side effects, daily use |
| New start with suicide risk or age 18–25 | 1 week, then by 4 weeks | Suicidality, agitation, sleep, safety plan |
| Dose increase or switch | 1 week, then as needed | Tolerance, mood shifts, adverse events |
| No response at 4 weeks | Prompt review | Dose, adherence, alternative options |
| Clear improvement | Every few weeks until stable | Symptom scores, function, side effects |
| Maintenance phase | Wider gaps once steady | Relapse signs, life events, withdrawal risks |
First 12 Weeks: What To Expect At Each Check-In
Week 1–4: Early Safety And Tolerance
The early window needs close eyes on mood and behavior. People can feel jittery, low, or restless before mood lifts. A brief contact at 1 week is advised when risk is present or when the person is younger. For others, a visit at 2–4 weeks works well. Use a tool such as PHQ-9 or a short mood log to track change, and ask about sleep, appetite, stomach upset, and sexual function.
Week 4–8: Response, Dose, And Options
By week four on a therapeutic dose, the plan should be assessed. If there is little or no lift, check daily use, interactions, and barriers. Then weigh choices: keep going a bit longer, adjust the dose within the licensed range, swap to a different agent, or add a talking therapy. When side effects are tough, a switch may make more sense than pushing the dose. Every change should trigger closer monitoring until things settle.
Dose Changes: Extra Contact
Any increase can bring fresh side effects and mood swings. Book a quick check one week after the change, then again within four weeks, with extra calls if risk rises. Log new symptoms the same day they show. If agitation or dark thoughts show up, contact the prescriber the same day.
Why Review Timing Matters
Early reviews catch suicidality, activation, and drug-drug issues. Timely adjustments raise the odds of remission. Regular contact also builds trust and helps people stick with treatment long enough to get the payoff.
Clear dates and one agreed step at each visit keep care steady and make change easier to stick long-term.
After Improvement: Maintenance Reviews And Duration
Once symptoms have eased, keep the same dose for a while to lock in gains. Many people stay on medication for at least six months after remission. Those with several past episodes, severe past episodes, or lingering symptoms often need longer spans, such as 12–24 months, and some stay on long term. Space out visits after a stable run, but do not drop them entirely. A steady rhythm helps spot creeping relapse, side effects that appear late, and life events that raise risk.
Mid-course reviews can be short and focused. Scan mood, function at work or study, sleep, sex life, weight, blood pressure where relevant, and any new medicines. If scores and function stay steady for months, widen the gap. If life gets rough or symptoms return, close the gap again. See the NICE recommendations on review timing and the FDA monitoring advice on suicidality.
Signs You Need An Earlier Review
- New or worse thoughts of self-harm or suicide.
- Severe anxiety, agitation, insomnia, or restlessness that does not fade.
- Mania-like signs such as little sleep with racing thoughts.
- New medicines, alcohol binges, or drug use that may clash with the antidepressant.
- Pregnancy, a plan to conceive, or breastfeeding.
- Falls, low sodium symptoms (thirst, confusion, cramps), or bleeding issues in older adults.
Switching Or Stopping: Review Milestones
Switching agents or tapering off calls for a plan. Give the body time to adjust. Cross-tapers and washouts vary by drug class. Set the first check at one week when risk is present or age is 18–25, and at two weeks for most others, with a follow-up by four weeks. If withdrawal signs surge, pause the taper or step back to the last dose that felt okay, then move down in smaller steps.
| Situation | Near-Term Plan | Watch-Fors |
|---|---|---|
| Cross-taper start | 1-week contact, then by 4 weeks | Dizziness, nausea, mood dips |
| Simple taper | Step down every 2–4 weeks | Brain zaps, flu-like signs, insomnia |
| Severe withdrawal | Return to prior dose, slower steps | Falls, panic, marked low mood |
How To Make Each Review Count
Bring Data That Speeds Decisions
Carry a one-page sheet with PHQ-9 scores, sleep hours, and a short note on work, study, and relationships. Add a list of all medicines and supplements with doses. Add alcohol and nicotine use in units per week. This keeps the visit brisk and precise.
Questions That Keep Care On Track
- What change in mood and energy have you seen since the last visit?
- Which side effects are new, fading, or still tough?
- Is the dose easy to remember and take daily?
- Any life shifts that raise stress or risk?
- Would a talking therapy add value right now?
Red Flags That Need Same-Day Help
Rapid mood swings, new self-harm plans, chest pain, shortness of breath, seizures, or signs of serotonin toxicity (sweats, tremor, fever, confusion) need urgent care. Do not wait for the next slot.
Special Situations
Older Adults
Start low and watch for falls and low sodium. Track weight and appetite. Some drugs interact with diuretics and pain pills. Plan reviews a bit closer at the start and after any change.
Pregnancy And Postnatal Period
Plan early reviews in pregnancy and after birth. Balance mood care with fetal and infant safety. Set shorter gaps after any change, and keep a clear record of doses and symptoms.
Co-Prescribed Lithium Or An Antipsychotic
Lithium needs blood tests at set times and steady dosing. Antipsychotic add-ons need weight, glucose, and lipid checks on a schedule. Align antidepressant reviews with those dates to cut extra trips.
What A Good Review Looks Like
A tight review is short, clear, and action-led. It checks mood scores, daily function, and side effects; screens for suicide risk; looks for drug interactions; sets one next step; and sets the next date. The person leaves with a plan they can follow.
Measuring Change Without Extra Burden
Short scales give a shared yardstick. PHQ-9 for mood, GAD-7 for anxiety, and a single sleep item tell a lot when tracked each visit. Many teams add a side effect list that rates nausea, bowel changes, headaches, sweating, sexual function, and weight from 0 to 3. The score trend guides dosing and helps spot when a stale plan needs a reset.
Numbers are not the whole story. Bring real-life anchors: out of bed by a set time, eating two meals, going outside each day, or texting one friend. When these anchors hold for weeks, spacing visits often feels safe. When they slip, bring the next check closer.
Common Timelines By Drug Class
SSRIs and SNRIs can take weeks to lift mood. Bupropion may aid energy. Mirtazapine may aid sleep and appetite. TCAs have niche roles and need care with interactions. The right pick is the one a person can take daily and that fits their health background.
Cardiac risk, bleeding risk, and hyponatraemia risk reshape follow-up. Set a lower threshold for ECGs or labs when history points that way. Keep a shared list of all meds, including over-the-counter drugs and herbs, and update it at every visit.
Practical Ways To Keep Reviews On Time
- Book the next date before leaving the room.
- Use calendar alerts and a pillbox that matches the dose schedule.
- Write a one-line goal for the next visit, such as “sleep 6 hours” or “walk 20 minutes.”
- If transport or timing is a barrier, ask for a video or phone slot; safety reviews can still be done well.
Switching And Tapering: Extra Detail
When switching within SSRIs, a cross-taper is common. When moving to or from MAOIs, longer gaps or strict diets apply. For venlafaxine or paroxetine, plan smaller steps and longer tails to limit withdrawal. A chart with dates, doses, and target signs helps the person know what to expect and when to call.
Withdrawal can bring brain zaps, nausea, sweats, vivid dreams, and mood dips. Most fade within one to two weeks. If a wave hits hard, pause, let symptoms settle, then step down in smaller moves.
Relapse Prevention After Stopping
Once off medication, keep reviews on the calendar. Early relapse can hide in sleep change, rumination, and low energy. A short check at one month, then at three and six months, helps catch trouble early.