Overview
Chronic depression often develops alongside disrupted sleep, low energy, reduced motivation, anxiety, and physical symptoms such as pain or fatigue. Over time, medicines can accumulate as different treatments are tried, sometimes leading to unclear benefit, overlapping effects, or side effects that worsen mood or function.
A medication review is a detailed clinical assessment of your current and previous medicines. The goal is to improve the overall balance of your treatment plan by identifying what is helping, what may be causing problems, and what changes could improve stability, clarity, and quality of life. This may include adjustments to dose, timing, combinations, or a plan to change medicines gradually when appropriate.
Who This Treatment Helps
A medication review may be helpful for people with:
• Persistent depressive symptoms despite medication trials
• Side effects such as fatigue, weight change, emotional blunting, or sleep disruption
• Complex prescriptions, multiple medicines, or uncertainty about what is working
• Co existing anxiety, chronic pain, or nerve related symptoms affecting mood
• Sensitivity to medicines or difficulty tolerating dose changes
• A history of partial response with relapse or fluctuating benefit
A consultation is required to confirm what type of review is most appropriate and whether coordination with your GP or mental health team is needed.
What Is Medication Review and Optimisation
Medication review and optimisation is a structured clinical process that aims to improve outcomes and reduce avoidable harm. It may include:
• Reviewing your full medication list including prescriptions, over the counter medicines, and supplements
• Assessing current symptom pattern and how it relates to your medicines
• Identifying side effects, interactions, or overlapping actions
• Checking dose timing and whether it supports sleep and daytime function
• Reviewing previous trials and reasons treatments were stopped
• Creating a clear plan for adjustments with realistic goals and monitoring
The aim is not to change medication unnecessarily. The aim is to make treatment clearer, safer, and better aligned with your current needs.
What to Expect During the Appointment
Your review typically includes:
• A detailed discussion of symptoms, sleep, energy, mood pattern, and daily function
• A full medication history including what has helped and what has not
• Side effect assessment including appetite, weight, concentration, libido, and emotional range
• Review of relevant medical conditions that may influence medication choice
• Discussion of lifestyle factors such as work pattern, stress load, alcohol, and caffeine
• Where appropriate, a plan for monitoring mood and function over time
If needed, your consultant may recommend coordination with psychiatrists, psychologists, or your GP to ensure safe shared decision making and continuity.
After the Review
If changes are recommended, your consultant will provide a clear plan that may include:
• What will change and why
• How quickly changes should occur
• What to monitor and how to track progress
• When to follow up and review response
• What to do if symptoms worsen or side effects appear
Medication changes are often gradual. The plan is designed to reduce disruption and avoid sudden shifts that can trigger rebound symptoms.
Benefits
Potential benefits of a structured medication review include:
• Clearer understanding of what each medicine is doing
• Reduced side effect burden where possible
• Improved sleep and daytime function through timing and dose planning
• Better symptom control through a more coherent treatment plan
• Increased confidence in next steps rather than repeated trial and error
• Improved ability to engage in therapy, routine, and recovery strategies
Possible Risks and Side Effects
The review itself is non invasive, but medication changes can carry risks depending on what is adjusted. These may include:
• Temporary symptom fluctuation during dose changes
• Withdrawal like symptoms if changes are too rapid
• Sleep disruption during transition periods
• Anxiety or low mood changes while the body adjusts
• Interaction risks if multiple medicines are involved
Your consultant will discuss these risks and plan changes carefully to minimise disruption.
When to Consider Other Options
Medication review is one part of a wider care plan. Your consultant may recommend other or additional approaches when appropriate, such as:
• Psychological therapy support such as CBT and ACT
• Sleep focused interventions and routine restructuring
• Treatment of co existing chronic pain or nerve sensitisation
• Specialist options such as IV ketamine infusion in selected cases
• Referral to psychiatric care when specialist prescribing oversight is needed
Safety Note
Please bring an accurate list of all medications and supplements, including doses and timing. Inform your consultant about allergies, pregnancy, heart conditions, liver conditions, past adverse reactions, and any history of substance misuse. If you have urgent deterioration in mood or safety concerns, seek immediate medical support through appropriate urgent services.
Arrange a consultation to discuss a structured medication review and a clear plan to support long term stability and function.