Tania Hristova

wantin f AD BS
Ircaigea pg-lQs!>

New Court Surgery
Borough Fields
Royal Wootton Bassett

Dr Claire Balysz Swindon
Assistant Coroner Wiltshire
Wiltshire & Swindon Coroner's Office SN4 7AX
26 Endless Street

Salisbury

Wiltshire

SP1 1DP

Date: 22'" December 2015

Dear Dr Balysz

Inquest touching on the death of Tania Hristova (Date of Death — 17.11.14)
Regulation 28 Report request addressed to New Court Surgery

We write following receipt of the Regulation 28 report issued by the Coroner, the contents of which have been
noted.

It is noted that Dr Bailes attended the inquest on 6" May 2015 on behalf of the partners at the surgery to give
evidence as a factual witness. He was not declared an Interested Person. The Record of Inquest recorded a
conclusion of suicide. The partners wish to pass on their condolences to the family of Mrs Hristova.

Thank you for granting an extension in respect of the response making it due by 31* December 2015.

In response to the two points as set out in section 5 of the Regulation 28 Report, we provide a response with
supporting evidence.

The partners at the surgery have had detailed discussions and taken a number of steps to address the concerns
raised and improved the care and service provided to patients taking SSRI antidepressants. The partners have
taken a number of steps to ensure that regular medication reviews are undertaken and patients are actively made
aware of the mental health support services available to them.

A significant event meeting was held on 11" May 2015 and 12™ May 2015 to discuss learning points and actions to
be taken. A number of steps were implemented and these will be set out in the course of this response.

Medication Reviews and repeat prescriptions

At the significant event meeting, awareness was raised about the use of medication review codes. It was agreed
that a written summary of the medication review was required to be recorded in the patient’s notes with the
medication review “read code” The use of medication review codes allows reliable audits to be performed and to
identify patients that require a medication review.

An audit was undertaken to help identify patients on SSRI antidepressants that were due to have a 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 a medication review on their reorder form when they request a prescription. There is a
“counting down’ procedure each time they request a repeat prescription. Patients that repeatedly ignore this are
being contacted by telephone or letter asking them to make a medication review appointment or a message
asking them to make an 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 on, (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 would 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.

The partners have taken substantial additional steps to address the points raised and are confident that there is a
robust system in place at the surgery to ensure appropriate medication reviews and the offer of counselling to all
patients taking SSRI antidepressants.

If we can assist further, please do not hesitate to contact us.

Yours sincerely

Partners at New Court Surgery
Enc.

1. Copy letter sent to patients on SSRI antidepressants
2, X2 leaflets from Patient.co.uk

Ms ee ~

Leaflet qo Wootton Basen
Witsoe me
SNA TAX

BR? onvaa aszane (E onsaesuia

' : z t . 4 Feb 2016

Coming off Antidepressants

al College of Psychiatrists, the professional body responsible for education, training,

This leaflet is provided by the
ychiatry, They algo provide readable, user-friendly and evidence-based information on

getting and raising standard:
various mental health prabienrs.

‘The aim of this leaflet is to help you decide about when and how to come off antidepressants.

Some people find coming of antidepressants is quite easy. Bul others may get withdrawal or a return of he depression.
We asked people to tell us what it was like for them to come off antidepressants, This leaflet brings together the views of
the 817 people who completed our survey and shared their experiences.

Survey findings

In our survey, the rnost common drug stopped was citalopram, This was taken by 236 people, Fluoxetine was next, taken
by 173 people, followed by venlafaxine (109), sertraling (89), excltalopram (51), Mirtazapine (38), paroxetine (29) and
duloxetine (26).

36% stopped their antidepressant suddenly. Males were more likely to do this (m=44%, f=34%). Younger people were also
more likely fo stop suddenly (59% of 18-24 year-olds comparec with just 20% of the over-65s).

§12 (63%) people In our survey experienced withdrawal when stopping their antidepressants,

Some drugs were more likely to cause withdrawal than others. nthe table below we have split the drugs into 3 groups

(high, roedium and tow withdrawal).

High Mediam Low

% with % with % with

withdrawal w thdrawat withdrawal !
Veniafaxine 82% Sertraline 82% Fluoxetine 44% \
Escitalapram 75% Citalopram 60% Mirtazapine 21%
Paroxetine 69%
Duloxetine 69%

A further 43 people were on tricyclic antidepressants. 63% of them had withdrawal, 23 people were on other types of
antidepressant, but the individual numbers on these drugs were too small to be able to draw conclusions.

Common withdrawal symptoms

Overall, the most common symptoms were:
e anxiety (70%)

dizziness (61%)

vivid dreams (51%)

electric shocks / head zaps (48%)

stomach upsets (33%)

flulike symptorns (32%)

depression (7%)

headaches (3%)

suicidal thoughts (2%)

insomnia (2%)

oot oe ew HO

Anxiety was the most corimon symptom for every antidepressent except duloxetine, for which ‘dizziness’ was the most
commen. The least common symptoms across all types were stomach upsets and flu-like symoloms. These patterns were
ihe same for men and waren,

Why do peopie stop?
The people in our survey decided to stop for a number of reasons:

Reason for stopping Number of people

44 May 2016, 14:43:34 Tha conten! nravided in his leaflet Ie fer information purposes only. Its nol designed to diagnose of esl a tondiian or cthorwise provide merical
advies, Information contained in Ihis i@atlal is also subject to pareanal interpretation and c&a bevone obsolele, this accuracy canns! bé guaranieed
Page 1 of 4 Please consult yaur own healthcare provider regarding any medical issues Copyright @ 2015, DXS Lid, All Rights Reserved

: Felt better 219
Side-effects 243
Dico't help 178
Wanted to try withoul 45
Pregnant ag

ai

On advice of doctor

When to stop?

Deciding when to slop is really important.
If you have had one episode of depression, you are usually advised to stay on antidepressants for 6 months to 1 year after

you feel better. If you stop too soon, your depression may come bac.
If your problems have been going on for some time, your doctor may advise you jo stay on antidepressants much longer.

Itis Important to be aware of two things if you do slop:

> You may get withdrawal.
* The conditian for which you wera taking your antidepressants may come back,

Seeking advice
We strongly advise that your decision to stop is made with your doctor.

tn our Slirvey:

» $72 people got advice from a professional
95 from the internet
75 from the Information leaflet pravided with their pills
36 from someone who had stopped antidepressants
289 did nat seak advice

“A quarter of people in our survey were nol aware that here could be problems linked with stopping.

What is withdrawal like?

People in our survey reported that the symptoms generally lasted for up to 6 weeks. Asinall percentage of symptoms
lasted longer than this. A quarter of our group reported anxiety lasting more than 12 weeks.

Of the common symptoms reported, the one rated severe by most people was anxiely. The symptoms that were rated
moderate by most people were stomach upsets, flu-like symptoms, dizziness, vivid dreams and electric shocks/brain zaps.
The less common symptoms were reported as severe: relurning depression, headache, suicidal thoughts, insornnia,

fatigue and nausea.

{ want to stop - how should | go about it?
We would suggest the foilowing:

BEFORE

« Make an informed decislon:

o discuss ihe options with your doctor

o be aware of possible withdrawal ar return of depression
e Make a plan:

co choose a goad time

o decide the speed of reduction

o who will you contact if there are problems?
» Seek support

o — from friends and family

o work - will you need some time off?

DURING
» Reduce slowly.
» Research suggesis:
2 o if treatment has lasted less than 8 weeks, stopping over {-2 weeks should be OK
o after 6-8 months of treatment, taper off over 6-8 weeks
© if you have been on maintenance treatment, taper more gradually: 9g, reduce the dose by not more Jhan V
every 4-6 weeks ’
e — Stay in touch with your doctor.
Be prepared to stap the reduction or Increase your dose again if needed.
Keep a diary of your symptoms and drug doses.
7
44 fay 2016, 11:43:34 TR coRA ee jn this Jeafiat is (or Information purposes only. It not dasigned to dieghose or treat 8 Condition oF othwewine provide mudical

information contalnad in this Wwaflet is alzo subject {¢- pertonal momeatalion ang can become obsolete, Ihus accuracy cannot be quaraniood.
Page 2 af 4 Please consult your own hwaltheaca provider regarding any Madical Issues. Copyright © 2015, OXS Lid. All Rights Reservad

AFTER
¢ Keep an eye on your moad.
lt may take some time before you fully stabilise,
Itis tmportant you look after yourself and keep active.
Keep practising cognitive behavioural therapy (CBT)/relaxation techniques if yau haye been taught these.
Go back to see your doctor is you are worrled about how you feel,

eee e

Advice from others who have stopped |
People who responded to our survey also made the following suggestions (we don't nacessarily endarse these
suggestions - we leave them to yau to consider):

Before deciding to stop
» Be prepared.
« Seek advice first.
«Research, but don't let online stories scare you.
« Listen to doctars and your own body and mind.
s Dor’'t feel sociatal pressure to come off. If you have a medical condition (diabetes/asthma etc) you shouldn't be
made to feel bad for taking medications.
Stop far the right reason. Not to please others.
Welgh up pros of laking drugs against the side-etfects from continued use.
If you dan't get on with the GP you've previously seer, ask to see one with an interest in mental health
It takes time/patience/perseverance.
ThinkAwrite down with semeone why you want to stop,

o> & © @

Once you have decided to stop
* Be sure you're ready; avoid stopplng during any disruptive periods in your life - the timing needs to be right.
Talk to someone else who's been there.
Let others know, Have support around you,
Understand the possible withdrawal symptoms you mighl experience
Have plans in place to manage your mood. Have something else to focus on.
Qet details of who to contact if you have a problem.
Advice for famlly/pariners would be useful.
View it iike recovery from an operation. Be good, focused and approach it In a lifestyle change sort of way.
If possible plan time off in advance.

During withdrawal
e Be prepared; sometimes withdrawal can take longer than expected.
« — Rest, drink water, eat healthily, and be kind to yourse'f.
» Take time off work if you need to

Dose adjustment
« Go slowly - reduce by small amounts,
Ask if you can reduce very slowly at the end with liquid instead of pills.
Keep some tablets In reserve so you can stop extra slowly.
Increase your dose temporarily ta control symptoms if needed.
Be aware that your symptoms may come back, at any time, if the dose is reduced further ,
Don't be ashamed to go back on antidepressants if needed.
Don't feel bad if you can't come off at 1st or 2nd atternipt,

ses te ew

Setting
¢ Avoid people/situations that may cause streas whilst coming off,

Activity and monitoring
«Keep a diary to reflect on your thoughts/feelings.
« Exercise.
« Avoid unnecessary responsibilities,
a Ask a friend or someone Close to you to monitor your mood in case you go dawn again - they might notice this

414 flay 2015, 17:43:34 The contant provided in this leallet is for Information purposes anly. IL ia not daaignad lo diagnose oF Haat a condition oF ollyerwise provide medical
. advice. Information contained In this leaflel te alse subjact to personal intarpzatation and can become obsolete, Ihua accuracy cannot be quaranw:ed
Page dof 4 Please consul your own heallheare provider cegarding any medical issuos, Copyrigh! © 2016, OXS Lid. All Rights Reserved

before you do.

Symptoms of withdrawal

« Just as side-effects are a sign that medications are getting nto your body, withdrawal effects are a sigh they are
leaving.

H you gat side-effects, don't allow other people to minimise thelr importance.

It's tough, but persevere; Ht will get better eventually,

Side-effects will pass - they are time-limited.

Be alert to feelings. If your mood gels worse or your anxiely Increases, it's not failure, it just might not be the tight
time to stop.

o Withdrawal symptoms may feel like a retum of depression,

eee

After withdrawal
« — Expect to feel a lille lower or flat for a while afterwards.
Seek talking therapy to gat to the foot of the problem/consider talking treatments as an alternative.
Keeping busy is the key to staving off the depression coming back, as your focus Is outside yourself.
You ate nol a failure if you can't come off them,
Recognise why you don't need them and be proud of ather ways you've helped yourself.
Try cognitive behavioural therapy (CBT).
De same exercise.

esesae

Sources of information suggested by our respo nders
¢ — hitp/antidepressanisieps.cc onvsell-halpfantidepressantsiwhenToStop.php
» — hitovy/Awww.rnind.org.uk/help/medical and_allernative_care/making sense of coming. off psyshiatric_drugs
«  http//antidepressantsteps.com/, uploads/booklet_f W2.ndf

Final comments

63% of people in our survey said they had experienced withdrawal or a return of depression. This is 4 higher figure than

other research suggests (about 30%). It is possible that the research has underestimated the problem, but it is also

possible that people were more likely te respond to our survey if they had problems stopping. \
Either way, we hope that you find the advice given in this leaflet useful.

We would also like to reassure readers that despite some people having symptoms of withdrawal when stopping

antidepressants, antidepressants are not addictive.

Content used with permission from the Royal College of Psychiatrists website:Con lepressants (October 2014,

due for review October 2017). Copyright for this leaflet is with the Rayal College o 5.

Disclaimer: This article is for information only and should not be used for the diagnosis of treatment of medical conditions.
EMIS has used all reasonable care in compiling the information bul make 110 warranty as to its accuracy. Consult a doctor
or other health care professional for diagnosis and treatment of medical conditions, For details see ourconditions.

Original Auther: Curtant Varsion: Peer Reviewer:
ROPsyeh RePsych RCPsych
Dasunient ID: Last Checked: Next Review:

* 28693 (v2) 12312015 4422/2018

Patlent Information
Copyright © 2013, Egton Medical Information Systems Limited

44 May 2015, 11:43%744. The contant provided in this leaflet ia fer information futpasas only, H ja not dosignéd to ciegnose oF Weal a condition oF olherwise provide medical
advice. Information conlained tn this leatial is alse subject ‘o porsonal inlerpratation Bnd can ‘become obsclete, thus accuracy cannot be guaraniaed
Page 4 of 4 Ploage consul your awn heallhcars provider ragarding any madical issuvs. Copyright © 2018, DXS Lid All Rights Resarvod

. : Mrs ios
Leaflet Borough Fialiés

alo Weollon Opsséti
‘ilishire
SNA TAX,
SEE o1res vszaoe fC) eizaaasite

& Feb 2014

SSRI Antidepressants

SSRI antidepressants are used lo {real depression and some other conditions. ‘They can take 2-4 weeks to duild up thelr
effact to work fully. A normal course of antidepressants lasts al least six months after symptoms have eased. Side-elfecis
may occur, bul are often minor. At the end of a course of treatment, you should gradually reduce the dose as directed by
your doctor before stopping completely,

SSR! antidepressants are not just for depression
SSRI stands for selective serotonin reuptake inhibitor. They are a group of antidepressant medicines that are used to treat
depression. (hey are also used to treai some other conditions such as builmia nervosa, panic disorder, and

obsessive-compulsive disorder,

How do SSRI antidepressants work?
Antidepressants alter the balance of some of the chemicals in the brain (neuratrangmitters), SSRI antidepressants mainly

affect a neutotransmitter called serotonin.

tlow effective are SSRI antidepressants?

About 5-7 in 10 people with moderate or severe depression have an improvement in symptoms within a few weeks of
starting treatment with an antidepressant. However, up to 3 in 10 people improve with dummy tablets (placebos), as some
people would have improved in this time naturally. So, if you have depression, you are roughly twice as likely to improve
with an antidepressant compared with taking no treatment. But, thay do not work in everybody. As a tule, the more severe
the depression, the greater the chance that an antidepressant will work well,

Note: antidepressants do not necessarily make sad people happy, The word ‘depressed’ is often used when people really
mean sad, fed-up, or unhappy. True depression is differant lo unhappiness and has persistent symptoms (which often
include persistent sadness). See separate leaflet called Depression for more information about this condition.

The success rate of SSRI antidepressants can vary when used to treat the other conditions listed above (bulimia, panic
disorder and obsessive-compulsive disorder).

How quickly do SSRI antidepressants work?

Some people notice an improvement within a few days of starting treatment, However, an antidepressant often takes 2-4
weeks to build up its effect and work fully. Some people stop tr2aiment after 8 week or so thinking it is not helping. (tis
best to wail for 3-4 weeks before deciding if treatment with an SSRI is helping or not.

If you find that the treatment Is helpful after 3-4 weeks, it is usual to continue. A normal course of antidepressants lasts at
least six months after symptoms have eased, If you stop the medicine too soon, your symptoms may rapldiy return. Some
people with recurrent depression are advised to take longer courses of treatment (up fo two years or longer).

When you are taking SSRI antidepressants

It is Important to take the medication each day at the dose preseribed. Do not stop taking an SSRI medicine abrupily. This
ig because you may develop some withdrawal symptoms. The dose is usually gradually reduced before stopping
completely at the end of a course of treatment, But don't do this yourself - your doctor will advise on dosage reduction
when the time comes. It is best not to stop treatment or change the dose without consulling a doctor,

Are there different types of SSRI antidepressants?

There are several different types. They include citalopram, esc'talopram, fluoxetine, paroxetine and senraline. Each of
these comes In different brand names. There is no best type that sults everyone. If the one chasen does not suit, it is
sometimes necessary to change the dose, or change the preparation. Your doctor will advise. Also, if SSRI
antidepressants do not help then another type of antidepressant may be advised.

What about side-effects and risks?

Most peopls have either minor, or no, side-effects. Possible sice-effects vary between different preparations. The leaflet
that cames in the medicine packet gives a full list of possible side-effects. You should read this before you start taking the
medicine. it is beyond the scope of this leaflet to list all side-effects, but the followlng highlights same of the mare comman
or serious anes.

As a cule, tell your doctor if a side-effect persists or is troublescrme. Your doctor can advise on the best course of actlon -

44 (May 2015, 14:44:84 The content provided in this leafiel is for information purposet ely. Ils nat designed to diagnose or treal a condilion or otherwise prey-de mevicat
advice information contaiad in Ihis loatiet 1a slo subject Le sersqnal Interpretation and can become obsalele, Ihus accuraey Cannot be guaranteed,
Page 1 of 3 Ploasa consult your awn beallheare provider regarding any madigat {ssues. Copyright @ 2015, DAS Lid. Al Rights Reserved

re

for exarnple, to stop the medication, a switch (a a different medicine, etc.

Tho most common side-effects
These include diarrhoea, feeling sick (nauseated), vomiting (being sick), arid headaches. It is worth keeping on with
ireatment if these side-effects are mild at first as (hey may wear off after a week ar so,

A possible sedating effect
SSRis can cause drowsiness (a sedaling effect) in some people. This side-effect Is not common, and is not as much of a
problem as with some other types of antidepressants. However, you must be aware of the possibility, especially if you are
+ a driver, as it may impair your ability to drive safely. Any sedative effect is likely to be greatest in the first month of starting
treatment, or on increasing the dose. The Driver and Vehicle Licensing Agency (DVLA) advises that you should not drive

during this lime if you feel that you are drowsy oF sedated at all.

Bleeding into the gut
Sore research has suggested that SSRIs may be associated with a small increased risk of bleeding into (he gut, but the

evidence Is inconclusive. This is especially In older people and in people taking other medicines that have the potential to
damage the lining of the gut or Interfere with clotting. Therefore, ideally, SSRs should be avoided if you lake aspirin,
warfarin, novel anticoagulants (such as dabigatran, apixaban and rivoraxaban) of non-steroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen, If no suitable alternative to an SSRI can be found and you have an increased risk of bleeding,
your doctor may advise thal you lake an additional medicine. This will help lo protect the lining of the gut.

Small increased risk of fractures
Research studies suggest that there is a srhall increased risk of fractures in people taking an SSRI. However, the reason

for this increased risk is not clear,

Nervous system side-effects
Dizziness, agitation, anxiety, difficulty sleeping, and tremor have all been reported as possible side-effects.

Sexual problems
Problems with sexual function arg @ common symptom of depression. However, in addition to this, all antidepressants may

cause some problems with sexual function, For example, problems getting an erection, vaginal dryness and decreased
sex drive have been reported as side-effects In some peonle,

Antidepressants and suicidal behaviour
In recent years there have been some case reports which claim a link between laking antidepressants and feeling suicidal,
particularly in teenagers and young adults, This may be more a risk in the first few weeks of starting medication or after a
dose increase. It is debatable whether this possible risk is due to the medicine or to the depression. If itis due to the
medication then the risk rernains very small. And, overall, the most effective way to prevent suicidal thoughts and acts is to
, leat depression. However, because of this possible link, see your doctor promptly if you become increasingly restless,
anxious or agitated, or If you have any suicidal thoughts. In particular, you should speak with your doctor if Ihese develop
in the early stages of treatment or following an increase in dose.

Are SSRI antidepressants addictive?
SSRis are not tranquillisers, and are not thought to be addicl ve. Most people can stop an SSRI without any problern. At
the end of a course of frealment you should reduce the dose gradually over about four weeks before finally stopping. This
is because some people develop withdrawal symptoms if the medication Is stopped abruptly. If you hava withdrawal
symptonts It does not mean that you are addicted to the the rnadicine, as other features of addiction such as cravings for
the medicine do not occur.
Withdrawal symptoms that may occur include;
« Dizziness
Anxlaty and agitation
Sleep disturbance
Flu-like symptoms
Diarrhoea
Tummy (abdominal) cramps
Pins and needles
Mood swings
Feeling sick (nauseated)
Low moar

ore ere ree

Those symptoms are unlikely to occur If you reduce the dose gradually. If withdrawal symptoms do occur, they will usually
last less than two weeks. An option if they de occur is to restart the drug and reduce the dose even more slowly.

How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicires you can report this on the Yellow Card Scheme. You can
do this online at the following web address: www. mhra.gov.uli/yellowcard,

pa
. 14 May 2015, 4 9:44:84 The contant provided in this Jnatlat (s for Information purposes only. this not der 1 to dizgriose or tent a condition oF otherwise provido modicat
advice. Informalian contained in this leaflet Is 01s0 nubjoct to porsonat interpretation and can ‘become obsolota, ihus acculaty donnot be guaronieed.

Page 2 of & Ploase consult your own haaltheate provider regarding any medical sues. Copyright © 2015, OXS Lid. All Rights Rosorved

OFS ANG QUISES BWAlE OI RNY NOW SIU eiGtle Ud IEMA IES

‘The Yellow Card Scheme ts used fo Make Pharmacists, dOct
nead to provide basic information about:

may have caused, Hf you wish to report a side-effect, you will
» The side-effect.
« The name of the medicine which you think caused it.
© — Information abaut the person who had the side-effect,
» Your contact details as the reporter of the side-effect,

It is helpiul if you have your medication - and/or the leaflet that came with it - with you while you fill out the report,

Further help & information

Mind
18-19 Broadway, Londen, £15 4BQ
Tel: (Infoline) 0300 123 3393, (General) 020 8519 2122

Web: wow. mind.org.uk

Further reading & references
e Depression In adults; NICE. Clinical Guideline (October 2009)
* — British Nation
¢ Depression;
Disclaimer: This article is for information only and should not bs used for the diagnosis or (reatment of medical conditions.
all reasonable care in complling the information but make no warranty as to its accuracy, Cansull a dactor

EMIS has used
or other health care professional for diagnosis and treatment of medical conditions. For details see ourconditions.

Original Author, Bt Tim Kenny Current Version; Or Gurviader Rut eee Mrs Jonny

Last Chacked: 12/10/2013 Document ID: 4376 Version: 40 © EMIS

Patient Information
Copyright @ 2013, Egton Medical Information Systems Limited

44 May 2015, 14:44:54 ‘Tho content providod in this leaflet is for information purposes only, is not designed ta diagnose oF {raat 6 condition ar otherwisa provide madical
advices Information contained in thes lente is algo subject 19 porcona! Iniezpretalien and con bacome obsolelo, thus accurnoy cannot be quarantend,

Page 3 of 3 Pioaee consul your own healthcare provider regarding eny modical souvs Copyright 2015, OXS Lid AD Rghts Rosorved

NEW COURT SURGERY

Borough Fields, Royal Wootton Bassett, Swindon SN4 7AX
Appointments & Enquiries Tel: 01793 852302
Secretary Tel: 851099, Fax No: 01793 851119
www.newcourt-wilts.nhs.uk Email; Prescriptions.newcourt @nhs.net
Dr M VALENTINE, DrJ BAILES, Dr R GONSALVES
Dr D MARSHALL, Dr J MADDISON

«SYSTEM_Date»

«PATIENT_Titley «PATIENT Forename! » «PATIENT_Surname»
«PATIENT _House»

«PATIENT_Road»

«PATIENT _Locality»

«PATIENT_Town»

«PATIENT_County»

«PATIENT _Postcode»

Dear «PATIENT Title» «PATIENT Surname»

As part of improving our Practice, we are currently reviewing all our patients on antidepressant
medication, We notice that you have had a prescription 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 past 6
months. The medication you are on can also be used for other conditions as well. If you have seen
a doctor about this medication recently, please contact the surgery and inform the receptionist, who
will inform your GP.

If you are feeling better and have stopped your medication, please let us know so that we can update
your medication list.

If you have stopped the medication and feel depressed or much worse, please contact the surgery
for a review before 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, liftawp.nhs.uk

We also enclose some standard leaflets about your medication.

If you have not seen a GP recently, please ensure you contact the surgery to book an appointment
for a review (this could be done over the telephone).

Yours sincerely

On behalf of New Court Surgery