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An audit was undertaken to help identify patients on SSRI antidepressants that were due to have medication review and arrangements were made to contact those patients to make a review appointment either by telephone or to take place in person at the surgery. There is currently a system in place whereby patients on repeat medications are notified that they ought to make an appointment for medication review on their reorder form when they request prescription_ There is counting down" procedure each time request a repeat prescription: Patients that repeatedly ignore this are being contacted by telephone or letter asking them to make medication review appointment or message asking them to make a appointment is added to their electronic prescription. As part of our investigations, we have contacted local pharmacists and asked them to ensure that the messages are duly passed on to patients. As part of improving our management of patients on SSRI antidepressants, partners agreed that we would write to all such patients to invite them to attend for a medication review and provide additional information about coming off antidepressants and about SSRI antidepressants generally. A copy of the letter is enclosed for information. As an additional measure, patients are also being advised to have an annual medication review in the month of their birthday. A repeat audit of patients on SSRI antidepressants was performed in October 2015. This consisted of a computer database search of such patients who are due to have a medication review: These patients are being considered on a case by case basis over the next 6 months as resources permit, The practice has reviewed its repeat prescribing system and has now upgraded to electronic prescribing: This allows messages to be added electronically to prescriptions which the patient can read themselves or the pharmacist can then pass 0n, (if their prescription is sent to the pharmacist): The surgery has also moved over to an online ordering facility through our clinical computer system. Patients register securely to obtain password and log in details, which then allows them to request repeat medications that still have issues remaining. Once the medication has reached its last issue it then require a medication review Offer of counselling/other mental health support services During the significant event review meeting; it was agreed that when a patient is started on SSRI antidepressants, they would be warned of the possible development of suicidal feelings and what to do should this occur_ It was discussed that patients should also be requested to discuss their condition and treatment with family/friends who may be able to then spot negative mood changes and/or suicidal thoughts. Awareness has been raised with the doctors to document this clearly in the patient records: It was also agreed that when starting antidepressants, clear follow up arrangements should be documented, It should also be documented that counselling/CBT has been offered and it should also be clearly documented as to whether the offer was accepted or declined, If accepted, the relevant arrangements should be clearly documented: The letter sent to relevant patients as included with this response also contained a link with information about the local mental health support services available through the NHS: There were also two information leaflets from patient.co.uk enclosed with the letter which provide general background information about SSRI antidepressants and coming off them_ We have also made available information on how to access counselling in the waiting room in order that such information is readily accessible to patients. they would

The partners have taken substantial additional steps to address the points raised and are confident that there is a robust system in place at surgery to ensure appropriate medication reviews and offer of counselling to all patients taking SSRI antidepressants. If we can assist further, please do not hesitate to contact us. Yours sincerely Jc ? Aai Partners at New Court Surgery Enc Copy letter sent to patients on SSRI antidepressants 2, X2 leaflets from Patient.co.uk the the

Nrs Lcaflet #otqh Fuekie Woolon Ba.S0It Wliehie SMTK 01794 05237 0179395119 Papent Feh 2015 Coming off Antidepressants This leaflel is provided by Ihe Royal Golleue ol Psychialrisis; Ihe professioral hody responslble for educatlon; training, setting and raising standards in psychiatly. They also provide readable, user- friendly evldelice-based Information on various rental health problems The aim of Ihis leaflet is to you decide abaul wherr and how to corne off antidepressents. Some peoplc find coning off antdepressants is qulte easy. Bul olhers may gel wilhcrawal or a return Of Ihe depression: Wc asked people to tell Us what il was Ilke for them to comie ofl antidepressants, This leailot brings together Ihe views of Ihe 81" people who compleled our survey ard shared their experiences. Survey findings In Qur sUrvey; Ihe mnosl conirnon stopped was citalopram This was taken by ?36 people, Fluoxctine wax rext, taken by 173 people , followed by verilafaxine (109), sertraline (89), escitalopram (51) , mirtazapine (38) , paroxetine (29} duloxeline (26). 36% slopped Ihelr anliclepressant suddenly: Males were more likely t0 dlo this (m=44%, (=34%}. Younger people were also more Ilkely (o stop suddenly (59% of 18-24 year-olds comparec with just 20% of (he Over-65s) . 512 (63%) people In our Survey experlenced wilhcrawal when g lopping Ihelr anlidepressauts Some drugs were more likely lo cause withdrawal Ihan olhers, nihe iable below we have splll the drugs into 3 groups (high, mediurn and low wilhdrawal): Kicyh Medlum Low % with %0 with % with wilhdrawal thdrawal withdrawal Venlafaxine 82% Serraline 82% Fluoxeline 449 Escitaloprali 75%/ Italopram 6u)9 Mirtazapine 21% Paroxetine 69% Duloxetine 69v A further 43 people were on tricyclic antidepressants. 63% of them had withdrawal, 23 peoplo were on other types of antidepressani, but the individual numbers on these drugs Were tO0 small to he able (0 draw Gonclusions: Common withdrawal symptoms Cverall; the most common symptoms were: anxiety (70%) dizziness (81%) vivid dreams (51%) eleclcic shocks head zaps (48%) slomach upsets (33%) {lu-like symptors (32%/) depression '%) headaches (3%) suicidal ihoughts (2%) insomnia (2%/) Anxiety was the most cormon symptom for every antidepressent except duloxetine , for whlch 'dizziness' was lhe most common: TThe least common symptoms across all types were lomach upsets and flu-like symploms These patterrs were tho same for men and women Why do people stop? The people in our survey decided (0 stop for rumber of reasons: Reason for etopplng Number of people 14 May 2016, 11.43.34 Tna corlenl nravidud ir Ilis Iaalel I fcr Informalio; Aurposns Gly nol cysigngd tlgnoso Icesi corildilija &r lhonwwiso provide mardka advica Icforalion cpnlalned Ihis leallal iv alzo subjoct pureanal inlevarclallon Brr cAn beecile ousolcle 'hus Occuracy Carral DA (uaraniund Page Pluzsa corisull yaur neukhcere providar rena(dinp @ny mudical issuas Copyrlghie 2015 , DXS Lid , AIl Riphls Reserved arid help drug and

Felt bettel" 219 213 Sicle-effecls 175 Dido" help 45 Wanled to tiy withoul 39 Pregnant 21 Qw advice 0f doctor When to stop? Deciding when lo slop is really Imporlant. antidepressants for 6 months to year after you have had ono episocia of depression; YOU are usually advised slay you feel helter: If You stop Ioo Soon, your dlepression may come back: proelers (YaVc been going Or for soine lirne, your doctor may advise you {o stay on antldepressants much longer: YOur Importent {0 Je aware 0f two Ihlngs you dlo slop. You may get wilhclrawal: Thie condition for Which YOu were iaking your antidepressants may come back. Seeking advice We strongly acvlse that your decision i0 stop is Inade wilh your doctor: In our survey: 372 people got advice from professianal 95 fram the internet 75 fram the Inforiation leaflet provided with their pills 35 from someone who had stoppud antidepressanls 289 did not seek advice A quarter of people in our survey were nol aware thal there could be problems linked with stopplng_ Pebait in oi ttcea enorieelhal (he genorally Ias ed for up lo 6 weeks. small percentage ol symplorns People in our survey reparted syinploms Iasled] lanyer Ilian lhis A quarter of our group reported anxiely lasling more Ihan 12 weeks: Of he comiron symptoms reported, Ihe orie rated severe by most people was anxiely The sympioms Ihat were rated moderate by Inosi people Were stomach upsets, Ilu-like sympt Jms , dizziness; vivid dreams and electric shocks/brain zaps. Thc less common symptoms were reported as severe: reluirnirig depression heaclache , suiciclal thoughts, insomnla, fatigue and nausea want t0 Stop how should go about it? We would suggest the followlng: BEFORE Make an informed decislon: disCuss the options with your doctor be aware of possible withdrawal ar relurn 0f depression Make plan: choose & good time dacide the speed of reduction who will you contact if Ihere are problems? Seek support: from friends and family work will you need some time off? DURING Reduce slowly. Research suggesis: trealment has lasted less than 8 weeks, stopping over (-2 weeks should be QK after 6-8 months of traatmient, taper off over 6-8 wweeks ifyou have been on maintenance treatment, taper more gradually: 0g, reduca the dose by not more Ihan % every 4-6 weeks in touch with your doctol. Be prepared to the reductian or increase your (lcige again if needed, Keep a diary of your gymploms arid drug doses Tn conkenl prondad Inila leaillut i (ox Intormalon Qufc 62 OnY nol dariurtes iQ dicq Os0 Ct Neni Q Cocji On Ouiawino providc IU (al 14 May 2016, 11,43.34 OIVice clolnud In Ihf; tnalol I5 Jko Mie oreonal elorrataion onJ C nceom: Otololc Inue acCUOCY connou bo guotfmood "IuG€ constm gom Conalnan Caa povicur {earding Ony(4dic esuc> Copyngl 2016, Dxs Lid AI Rlanks Flusgivnu Page Slay 'stop

AFTER Keep an eye an your mood: Il may Iake somC Iimne before YOU iully stabilise_ It is Important you look after yourself and keep active_ Keep practising cognitive behavioural therapy (CBTJirelaxalion techniques if you have been taughi these. Go back lo s80 your doctor is you arc warrled about hOw you feel. Advice from others who have stopped People wha responded t0 our survey also made the following 3uggeslions (we dor" necessarily eridorse those stagestions we leave them to you to consider): Before deciding to stop Be prepared: Seek advice first, Research, bul dont let online stories scare you: Listen i0 doctors and your own body and mind. Don"t feel sociotal pressurc: lo come off. If you have , medical condition (diabeteslasthma elc} You shouldn"t ho made to feel bad for" taklng medicatione. Stop fr the right reasoil, Nut t0 plcase others_ Welgh uP pros of cirugs against the side-etfecis from contirued use . Ifyou don"t get on the GP you've previously seari; a8k to see One with an interest in mental heallh It lakes timelpatiericelperseverance Thinklwrite down with somieone why you wanl t0 slop, Once you have decided t0 stop Be sure yoUre ready; avoid stopplng during atiy disruptive periods in your life the timlng needs to be right, Talk to someone else who's been there Let others know, Have support around you; Understard the posslble wlthdrawal symploms you mighl experience Have plans In place I0 manage your mood. Have somelhing else to focus on; Oet detalls of who t0 contact If yOu have a problem: Advice for famllylpariners would be useful: View It Ilke recovery from an operalion: Be goocl, focused And approach It In a lifestyle change sort of way- If possible plan tine off in advance. During withdrawal Be prepared; sometimes withdrawal can Iake longer than expected; Rest; drink water; eat healthlly. and be kind to yourse f Take time off woik if yOu reed t0 Dose adjustment Go slowly reduce by small amounts Ask if you can reduce very slawly at the end with liquidd instead of pllls . Keop some tablets In reserve 80 you can Btop exlra slowly- Increase your dlose temporarlly to control symptoms Il needed, Be aware Ihat your symptoms comie back, al any time , if the dose is reduced further Don't be ashamed t0 go back on antidepressants if needed. Don't feel bad if you cantt corne off at Ist or Znd alterript, Setting Avoid peoplelsituations that may cause stre8s whilst coming off. Activity and monitoring Keep a diary to reflect on your thoughts/feclings. Exercise, Avoid unnecessary responsibilities, Ask a friend or someone close to you to monitor your mood in case You go down againr - they might notice Ihis 14 May 2015, 11;43.34 Cho conlonl provided Ihls Ieallcl is Tor Inlofmalian purposes cnly: nol Dugignod diqhnqbu %u Iionl corrilon Df aliense [rovide medleal AIdvice. Informialion coniuingd In Ihis Iaallel ulyu subjact Io Ferscnal iciorpalalion and can bacorc obeolalo: Ilwa pccurtcy crol bu guarunkaod page 3 af 4 ploals d consull YCJr Qwnhealihcaro rejardlng eY Mrdlcal issln Copyrighl R01 pXS Lio AII Righ , Ao' -tveu aking with may Piovidne

betore you do. Sympioms Of withdrawal medicalions are getting Into your body, withdrawal effects are sigr they are Just as side-effects are a sign {hal leaving: Kf you gat side-effects, don" allow other people to mininlse their imporlance: Irs tough, but persevere; It will get better eventually. Side-effecls will pass they are time-limited ils nol {ailuro, it inighl not be the right Be alerl to feelings. If - Iood gels worae Of anxibly Increases; tirne t0 siop_ Wilhadrawal symploms may feel like & relur of depression, Afier withdrawal Expect (o fecl a lillle lower or Ilal Ior & Whila alterwards Eeeecalking therapy @ etto ihe rool of the problerntconsider lalking (reatments &8 an alternalivee is Ihe {0 slaving off Ihe dopresslor coming back, as your focus is outside yoursell: Keeping busy Youi are no( failuro If you car"( come ofl Ihem; Rognise why You con" need Ihen and be proud of xther ways youtve helped yourself. bchavioural Hherapy (CBT) Da soine exercise: Sources 0f information suggested by our responders Ip Lanlidepressantsleps com/sell helpfanlidepressintsWhenToSlop phP khelplmedical_and_allernalive_carclmakig_sense_of_coming_olL_psychlalric_druas lllim mind.org hup anliepressantsleps com/_uploadstbooklel_IulllZ_Qlf Final comments said they had experienced wilhdrtwal or & relurn of depression Thls Is a higher fguso than 63% of people In aul' survey thal (he research has (inderestimeted (he problem; but it is also Olher research suggests (about 30%). Il is possible possible thai peoplo were rore likely lo respond t0 our survey if had problems stopping: Ellher way wG hope thal you find the advice given in (hls leallat useful; of withdrawal when stopping We woula also Iike lo reassure readers that aespite some people having symptoms antidepressants, antidepressants are not addictive: of Psychiatrists webslte Coming Qlf_anlidepressauts (October 2014, Corterit used with permission fromi Ihe Royal College Confortevieed/ Oclobem20519n 'Copyright for this loaflel Is wih the Rayal College of Psychiairisis. Disclaimer; This arlicle Is for information only and should not be for the diagnosis or Irealmont of medical conditions_ care ia compiling the Informalian bul mnake "0 Warranty G8 (0 Its accuracya Consult & doctor EMIS has used all reasonable (reatmont (f meclical conditions For delalls see quiconclilions or other hoalih care professional for diagnosis and Original Auihcr: Current Version: Peer Reviewer; RCPsych RCPsych RCPsych Docunent ID: Last Checked: Next Revlew: 28693 (V2) 1/23/2015 1/22/2018 Patlent Information Copyrlght @ 2013, Eglon Medlcal Informalion Systemng Limited Tho conianl provicodi this Ieailel is Ior inlormalion purposar orMy:. Iis tot dcsionod diaanosa %r Iroal # condinizn ar olneiwise provlde medtal 14 May 2015, 11,43;34 mogcmation corlained In Ihls Iaal %l also sub1ec parsoval ilerprolalion Amxl czn bczornu obadluly;_Ihu: OcCurocy cannal Gudranined puwvace consum hrallhcara provider raparding 9nY modical Isguby Copyuigh @ 2015.UXS Lid AVI Righls Resotvrim Page Pioase Your just your vour key cognitive Tiy thev used

Mrs Leaflet uxrcugh Ficlos Waollon asscil Willshiie SNA TAX 096793 052307 04792 85419 Patient Fob 2014 SSRI Antidepressants SSRI anlidepressarils are usecd |o (real depression and some Olher condilions "Ihey can take 2-4 weeks to build Up Iheir elioct lo woik F fully. A normal course of anlidepressanls Insls &l Ieasl alx mnonlhs after symptoms have eased, Sidu-elfec s may OCCUr, Jul are often minor. At the end 0r & cotrsc of (reatraent; you should gradtally reduce the dose as directed by your dioctor before slopping complctely; SSRI antidepressants are not just for dcpression SSRI stands for seleclive serotonin reupiake inhibltor. They are group of antidepressanl medicines Ihat are used l0 treat depresson. rhoy are also used to treai some other conditions suchi as bullmia nervosa, panic disarder; and obsessive- compulsive disarder. How do SSRI antldepressants work? Antidepressants alter Ihe balanice of sore of the chemlcals in the brain (neurotransmilters) . SSRI aritidepressants mainly affecl a neurotransmiilter called serotonin, How effective are SSRI antidepressants? About 5-7 in 10 people wilh moderate or severe depression have an improvement In symploms wilhin a few weeks of slaring (realrrient will an antitiepressanl However up fo 3 in I0 people improva with dummy tablets (placehos). us some people would have improved in Ilis lime naiurally. So, if you have deprossion, YQU are roughiv twice a5 Ilkely t0 Improve wilh an anlidepressant compared wlth iaking no trealmerit. But, they do not work in everybody. As a rule, ina more severa the depression, Ihe greater iIhe charce Ihal an anlidlepressant will work well, Note: anlidepressanls do not necessarily make people happy: The word 'dopressed' is ofteri Lisod when people really Itean satl, fed-LIp , Or unhappy: True depression is differonl Io unhappiness and has persistont symptoms (which often include persisteri sadress). See separato Iaatlel called Depresslon for more informalion aboul Ihis condition; The success rale 0f SSRI antidepressants can vary when used to traat the other conditlons listed above (bullmia, panic diborder obsessive-compulsive disorder): How quickly do SSRI antidepressants work? Some people notice an improvemeni within & few deys of starting treatrnent; Howevor; an antldepressant ofien takes 2-4 weeks (o build Up ils effeci and work fully. Some people stop treatment afor A weok or 80 thinking it is riot helping: It I8 besl lo wail for 3.4 weeks before dleciding I[ irealment wilh an SSRI is helping or not Ifyou Iind (hat the (realment Is helpful alter 3-4 weeks, is Usual lo conliriue Anariral course of anlidepressants lasts at least Six months after symnpioms have eased If you stop (he madiclne too so0n1, Your gymptoms may rapldly return. Some people with recurrenl depression are advlsed to {ake longer Co rses Of frealment (Up (0 two years Or lorger). When you are taking SSRI antidepressants It is Important l0 Iake Ihc medication each at the dose prescribed. Do nol stop taking an SSRI medicine abruplly. Thls is because YOu may develop sorne withdrawal symploms. The dose is usually gradually reduced before stopping completely at Ihe end of a course of (realment But don"t do yourself your doctor will acvise on dosage reductian when (he time comes It Is best nol to stop trealment or chenge: tha dose wittiout consuliing a doctor; Are there different types of SSRI antidepressants? There are several differeni iypes. include citalopram, esc talopram; fluoxetine , paroxetlne and sertrallne. Each af these comes In dllierent brand names_ There Is na best type Ihal sults everyone If the Orie chasen does not suit, it is sometlmes neceesary (0 Change Ihe dose or chango preparation: Your doctor wlil acivise . Also, if SSRI antidepiessants do not help then another type of artidepressalt may be advised. What about side-effects and risks? Most people have elther minor, 0r no, side-effects: Possible sice-effects vary between different preparations; The leaflet thal comes in the medicine packet gives a full Ilst of possible slde-effects: You should read this before you start taking the medicinc. It is beyond Ihe scope of this leaflet ta lisl all sida-effects, but the followlng highlights some of the more common or serious ones As & rule, tell yaur doctor if a side-effect persists or is troublescre: Your doctor can advise on the best course of action 14 May 2015, 11.44:51 Tnc confeni provided (nis Wallcl j Icx intormalicn purpose: cnly; nji vesienep diagnose Of Irgal cundllkn _ ollierxlso piav de medical @Cyice Infarmalion comaiind in Inis Ioatlel IJ elso subjccl lc xersonal Inlrrn olalion and can becomu dusalele, Ihus accAIracy Carinof |x gugrenteed_ Page of 3 Ploaso consult YoLy Jwn tieullhcarc (rovidcr regarding ony madlcal [s9409. Copwilghi = 201 DXS Lid AII Rinhis Raservad sad and day thi They thc

for exainple lo stop the medication, switch (a diltereni medicire eic Tho most common side-effecis (heing sick) , arid headaches_ It is worth keeping on with These include diarrhoea;{eeling sick (nauseated) , vomiling Irealmeni ihesc side-effects are mlld at first as ihey may wear off after a waek ar 80, possible sedaling effect This side-elfeci Is noi comon and is not 3s iuch af a SSRIs can cause drowsiness (a sedaling effecl) in some people: of the possibllity, especially il you are problem as with some olher lypes 0f antidepressanls However VOUenusl beeawaree in the first month of slerling 8 (river; as il may impair Vour ability I0 drive safely: seclalive effecl ic Ilkely to he greatest should HOl clrive increasirig Ihe dose, The Driver and Vehicle Licensing Agency (DVLA) advises Ihal you [realmeni, Or On) during Ihis lime if you feel (hat yu are drowsy O sedated at all: Bleeding into the associaledl wilh & small increased risk of bleocling Into Ihe gul; but the Sonc research has suggesled Ihal SSRIs may he other medicinus ihat have Ihe potentlal to evidence Is ircxnclusive. This is especlally In older people ard in pcople akirvg Iake aspirin_ Ihe: Ilning of Ihe gut or Interfere will? clolting Therefote, ideally, SSRIs shculd be avoided ou damage dabigatraln, apixaban rivoraxaban) or niOH-steroical ;nti inilarnmalory clucs. wsiard)s "ove / asticoprofent % (S0(SuableL baqerrative oa SSR Cal be found and You have an increased risk ol bleeding, (NSAIDs) such as ibuprofen: If no medicine This will help lo protect Ihe liriing of Ihe qut: your (loclor Way advise Ihal you lake €1) adclitional Small increased risk Of fractures risk of fractures in people {aklng an SSRI. Hcwever, (he reason Rescarch studies slggest Ihat there Is & small increased for this ircreased risk Is not clear Nezvteus syiiteon sidicetyfectticully aleeping, and Ireror have all been reporled as possible side-effecta: Dizzlness, agltation , anxiety, Sexual problems (urction a cormon symplorn Of depresslon: However, in addition to this , all antidepressants may Problems wilh sexual are problems getting An ereclion, vaginal dryness and decreased causo JOMe problems wilh Sexual (unction For axample, sex drive have bcen reported a slcle-effecls in some people, Antidepressants and suicidal hehaviour whlch claim a link beiween (aklng antidepressants and feeling suicidal, In receni Iherc have bcen some case repoits Tisk ir Ihe first few woeks of starting medicalion %r after & particularly teonagers and young Adults. This may be more & to Ihe depression. If Il is due to Ihe, dose increase. Il is debatable whether (his possible risk I8 due to the medicine Or suicidal Ihoughls and acts is to medicntion theri the risk rernains very smali, Anid , overall, Ihe most effective way to Drevene reslless _ depression. However, because Of Ihis possible Ilnk, See your cioclar prompily If you become Increasingly (real have any suicidal (houghts. In parlicular, should spealk with your doctor If iIhesa develop anxious Or agitaled, Qr in the early stages of (reatmeni or following an increase In do8e. GSRis SRHoi ftincsers andsar hdictought to be addicl ve: Mosl people can slop &n SSRI Wihout eny eroblem A SSRIs are rot tranquillisers, and are nol ! ahoul four weeks before finally stopping: Thls the end Ofa course of frcalmerit you shotld reduce the dose gradually over withdrawal (people dovelop withdrawal sympioms ir the medication Is slopped abruptlyaldlicou havel is because sorne Uhat addicied t0 Ihe Ihe mnadicine, as other features of addiclion such a8 cravings for syrptonis It does not mean you are the medicine do not occur_ Withdrewal symptoma thatmay ccur include; Dizziness Anxloly arid agilalion Sleep distuibarice Flu-Iike symptoms Diarrhoea Tumry (abdominal) cramps Pins and needles Mood swings Feeling sick (nausealed) Low moad These are unlikely to occur If you reduce Ihe dose gradually: If wlthdrawal symptoms do occre: sleywwill usually sythatoiwo weeks, An option If do occur Is fO restait Ihe drug and reduce (he dose even more slowly: last less than How to use the Yellow Card Scheme Ihie the Yellow Card Scheme. You can If you think you have had a side-effect to one Ol your medicires YQu can report on do this online at the following web address; WMK Lla gOV Ul lyellowcard providod 1 Ihis Innlot = (ot Infcimalan PWipa,05 Qy Wmmadedorad (o dizonoso %r Kradl " Corxilion olharwjo ptovido modlcu 14 May 2015, 11:44.51 Inu conioni canlulred In Ihls Iaollcl Is 0849 gubiocl porzon )i inle-erelalion In4c2n Docci" Obsoiuio Wsacuraty Qonioi Un quororuaed. 2 of ? Ploaso ConSt) YQu CATH hoUhc te Prowcur {opjoodiio Gny modkca /5uc; Ceprtighl $ 2015, OXS Lld Al Righis Rosorvod Page Any gut and yeais You You they

The Yellow Card Scherrie I8 used 10 make pnarmacists, (octors and nurses aware 0lfary %eov shoulicet Ld Miictiiliiig? may have caused, If you Wish t0 report a side-effect; you will neid (0 provide basic information aboul: The side-effecl; The name of thie medicine which Yu think caused It, Information about the person who had the side-effect Your contact details as Ihe repoiter of {he sida-effect, It is helpiul if you have your medication andlor the leaflel thal came wilh it wlth you whlle you fIll out the report, Further help & inforination Mind 15-19 Rroadway Londan; E15 4BQ Tel: (Infoline) 0300 123 3393, (General) 020 8519 2122 Weh; Www mhind OrqUk Further reading & references DepressiQu lackulls; NICE Clriical Guideline (October 2009) Brillsh Nalional Formulecy Doprossion; NICE CKS, August 2013 Disclairner: This article Is for information only and should nol b9 used for the dlagnosis or (reatmerl of medical condacos. EMIS Used alfreasonatle care in compiling Ihe information but make no warranty as t0 iis accuracy COnSull a dactor Other heatec care professionan for diagnosis Irealment of medical condilions For dotails soe Quicondlilion: Peer Revlewer; Mrs Jenny Original Aulhor; Dr Tim Kenny Current Version; Dr Gurvinder Rul Whitehali Last Checked: 12/10/2013 Document ID: 4375 Version: 40 EMIS Patient Information Copyrlght G 20 /3, Enton Medlcel Information Systerns Limited Thu canleril pfovidod Inux loollol foc infommillan purpueat &ly. IlA# nol deslonad lu dingcaso & kraal % condillon Or Olhcrwise Drovide Innd czi 14 May 2015, 11.44.51 Tnecr Inicrralion cunto n1cd in I Ionllat I Juljuoi [D Doxconai inicrorctalicn and cen tncone cosoicle Ihieclagy Gni bc Quuttrletd

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NEW COURT SURGERY Borough Fields, Roval Wootton Bassett; Swindon SN4 7AX Appointments & Enquiries Tel: 01793 852302 Secretary Tel: 851099, Fax No: 01793 851119 WWW newcourt-wiltsnhsuk Email: Prescriptionsnewcourt@nhs net Dr M VALENTINE, Dr J BAILES, Dr R GONSALVES Dr D MARSHALL, Dr MADDISON (SYSTEM_Datex (PATIENT' Titlen <PATIENT_Forenainel > <PATIENT_Surname) (PATIENT Housen <PATIENT Road) (PATIENT_Locality) (PATIENT' Town) (PATIENT_County) (PATIENT_Postcoden Dear' <PA TIENT_Titlen (PATIENT_Surname) As part of improving our Practice, we are currently reviewing ouI" patients on antidepressant medication. We notice that you have had a prescriplion for a medication that is used for depression in the last 3 months and that we do not have a medication review documented over the months. The medication are On can also be used for other conditions as well. If you have seen doctor about this medication recently; please contact the surgery and inform the receptionist, who will inform yout GP_ If you are feeling better and have stopped your medication, please let us know 80 that we can your medication list, If you have stopped the medication feel depressed or much worse; please contact the surgery for a review bcfore re-starting; It is important to treat depression and if you are interested in any Other methods of managing your depression or mood problems, You may find the following link helpful: WWW lifLAWDahs uk We also enclose some standard leaflets about your medication. If you have not seen a GP recently, please ensure ycu contact the surgery to book an appointment for a review (this could be done over the telephone)