Psychotropic medication reviews start early, repeat at 2–4 weeks, then at set intervals (often 3–6 months), with quicker checks when risk increases.
What A Psychotropic Review Really Means
A review is a planned check of how the medicine is working, what side effects are showing up, and whether the plan still fits the person’s goals. It is not just a refill chat. A good review looks at dose, symptom change, harms, blood tests when needed, drug–drug interactions, lifestyle fit, and a shared decision on the next step. Notes should record the plan, who is doing what, and when the next check will happen.
Review Cadence At A Glance
The time frames below reflect widely used guidance for common drug groups. Clinicians will tighten or loosen the schedule based on risk, age, and comorbid illness.
| Medicine Or Class | First Review After Start | Routine Review Frequency |
|---|---|---|
| Antidepressants (SSRIs/SNRIs/TCAs) | Within 2 weeks; 1 week if aged 18–25 or suicide risk | Every 2–4 weeks during titration; at least 6-monthly once stable |
| Antipsychotics (non-clozapine) | Early checks through the first 12 weeks | Annual antipsychotic review once stable; metabolic checks at 12 weeks and yearly |
| Clozapine | Specialist only; weekly bloods for 18 weeks | Then fortnightly to 1 year, then every 4 weeks |
| Lithium | Serum level 1 week after start or dose change; then weekly until stable | Every 3 months in year 1; then 6 months (3 months in higher risk groups) |
| ADHD medicines (stimulants, atomoxetine) | Early dose reviews with BP/HR checks | Specialist review at least once each year; vitals tracked regularly |
| Benzodiazepines and Z-drugs | Early review to plan short use only | Frequent checks during tapering; aim for the shortest course |
How Often Should Psychotropic Medication Be Reviewed: Timing By Situation
Starting Or Changing An Antidepressant
Set the first follow-up within 2 weeks to check response, adverse effects, and safety. If the person is 18–25 years old, or if suicide risk is present, set the first review at 1 week. Keep contact going every 2–4 weeks during dose changes. If symptoms have not shifted at 4 weeks on a recognised dose, revisit the plan.
Continuing Antidepressants To Prevent Relapse
Once mood has settled and the person stays on therapy to prevent relapse, book a review at least every 6 months. Each check should track mood with a simple scale, side effects, adherence, and any new health or social stressors that could tilt the balance of benefit and harm.
Using Antipsychotics After Stabilisation
During the first 12 weeks, clinics track weight, waist, BP, lipids and glucose while dose is adjusted. After stabilisation, keep a documented antipsychotic review each year. That yearly review confirms the indication, looks for movement side effects, runs through metabolic risks, and tests whether the current dose is still the right one. If shared care moves to primary care, make sure the plan shows exactly who is running the labs and who decides dose changes.
Lithium: A Special Case
Check a trough lithium level 12 hours post-dose 1 week after starting or any dose change, then weekly until the level is steady. When the dose is steady, measure lithium every 3 months for the first year, then every 6 months. In older adults, people on interacting medicines, or anyone with renal or thyroid risk, stick with 3-monthly. Alongside levels, repeat renal function, thyroid function, calcium and weight at least twice a year, with extra tests if kidney function dips.
ADHD Medicines
Plan early reviews as the dose is titrated, with heart rate and blood pressure tracked against normal ranges and weight tracked in growing people. A trained specialist should review the need for medicine at least once per year and set out whether a dose change, a break, or a switch is needed.
Benzodiazepines And Z-Drugs
These drugs suit short courses. Arrange a quick check to confirm the target symptoms, agree the shortest planned duration, and map a taper. When tapering starts, keep contact tight (often every 1–2 weeks) until the dose is off or settled.
What Each Review Includes
Symptoms And Function
Track core symptoms and daily function using the same rating tool each time. Tie the score to real-world anchors such as sleep, work, or study.
Harms And Safety
List new side effects, ask about falls, driving, and substance use, and scan for warning signs like agitation or mood switches.
Vitals, Labs, And Physical Health
Check weight, waist, BP and pulse where relevant. Order labs tied to the drug: lithium levels and renal and thyroid panels; fasting glucose or HbA1c and lipids for antipsychotics; liver tests and full blood count for valproate. Add ECGs if there are cardiac risk factors or the drug label calls for it.
Drug Map
Review every medicine on the list, including over-the-counter pills and supplements. Watch for interactions that raise levels, lower seizure threshold, or add sedation.
Adherence And Access
Ask what makes taking the dose easy or hard. Tidy up dosing times, pill form, reminders, and refill logistics so the plan is doable.
Shared Plan
Agree the dose plan and the next checkpoint. Write down red flags that should trigger an earlier call, and where to get help between visits.
Red Flags That Mean “See Me Sooner”
- Any surge in suicidal thinking, new self-harm, or rapid mood swings.
- New chest pain, fainting, palpitations, or shortness of breath.
- Sudden confusion, fever, or stiff muscles after a dose change.
- Rash, swelling of lips or face, or signs of infection while on clozapine.
- Thirst, peeing often, tremor, or diarrhoea while on lithium.
- Pregnancy, planning pregnancy, or starting a strong interacting medicine.
Monitoring Summary For High-Risk Medicines
Use this compact guide to plan tests that pair with reviews. Local protocols may adjust details.
| Medicine | What To Monitor | Usual Interval |
|---|---|---|
| Lithium | Trough level; renal panel; thyroid panel; calcium; weight | Level 1 week after start or dose change, then weekly until steady; every 3 months in year 1; then 6 months (or 3 months if higher risk). Renal/thyroid/calcium at least 6-monthly. |
| Antipsychotics (not clozapine) | Weight/waist; BP/pulse; fasting glucose or HbA1c; lipids; prolactin if indicated; ECG if cardiac risk | Weight weekly for 6 weeks, then at 3 months, at 1 year, then yearly; labs at baseline, 3 months, then yearly. |
| Clozapine | Full blood count plus the antipsychotic checks above | FBC weekly for 18 weeks, fortnightly to 1 year, then every 4 weeks; other checks as per antipsychotics schedule. |
| Valproate | Liver function; full blood count; weight | Baseline, at 6 months, then yearly; extra tests if symptoms suggest liver or blood issues. |
Who Leads The Review And How Visits Are Timed
During acute care or early titration, specialists often lead and set short gaps between contacts. Once stable, a GP or primary care team can run planned checks, with a named prescriber holding the thread. Video or phone can work for some steps, yet lab work, ECGs, weight, and movement checks need in-person time.
How To Personalise The Schedule Safely
Start from the class-based time frames, then tune the gap based on age, pregnancy plans, renal or cardiac risk, falls risk, past overdose, and help at home. Longer gaps suit stable people with steady results and no red flags. Short gaps suit dose changes, side effects, missed doses, high suicide risk, or polypharmacy.
Two Authoritative Anchors You Can Trust
UK guidance gives clear time points for early antidepressant checks and lithium monitoring, and sets an annual specialist review for ADHD drugs. Read the exact lines now in the NICE depression guideline and the NICE ADHD annual review standard now.
Safe Deprescribing And Switching
When stopping, map a taper that matches the drug’s half-life and the person’s history. SSRI and SNRI withdrawal can be rough, so smaller dose steps near the end help. Antipsychotic withdrawal should be slow and watched for relapse. Clozapine and lithium need close specialist input for any switch. Benzodiazepines and Z-drugs should step down on a set schedule with close follow-up.
Quick Planner: Your Next Three Steps
- Check your last review date and book the next one now, based on the schedule above.
- Bring a one-page log: current dose, any missed doses, top three benefits, and top three side effects.
- Agree the next checkpoint and tests before you leave the room, and write down when you should call sooner.
When Labs Or Vitals Change The Timing
Calendar rules bend when numbers drift. A steady climb in weight or waist on an antipsychotic calls for a faster visit to plan diet help, activity goals, and dose choices, and to review whether a switch is needed. A raised prolactin with low libido or menstrual change brings the review forward to weigh dose reduction, a prolactin-sparing agent, or a swap. Low sodium on an SSRI needs a same-week call to check for headaches, unsteadiness, or confusion, and to repeat labs. A lithium level outside the target range needs advice and a repeat level, with dose held or reduced until in range.
After Hospital Care Or A New Diagnosis
Discharge is a tight window. Book a near-term review, confirm repeat scripts, and share 24/7 contact routes. New diagnoses usually involve dose finding, so shorter gaps reduce setbacks. Handover letters should list the current dose, the last lab dates, and the next booked checkpoint so nothing gets lost between teams.
Remote Or In-Person?
Video or phone keeps momentum during titration and suits symptom checks. In-person visits fit movement exams, depot clinics, ECGs, and weighing. A blended plan works well: remote touch-points for early checks, paired with face-to-face reviews for labs and physical checks. After each contact, send a short written summary and the next date.