Medication Review

Our Ref: MR-2024-11-001 01/11/2024 Dr. Sarah Jenkins Maplewood Clinic 123 Health Lane Wellness City, WC1 2AB Dear Dr. Jenkins **Re: Sarah Peterson, 15/03/2008, NHS number: 987 654 3210** **Identified difficulties:** Sarah Peterson, a 16-year-old female, presents with persistent low mood, anhedonia, significant social withdrawal, and difficulty concentrating, suggestive of a moderate depressive episode. Her ICD-10 diagnosis, as stated by the psychiatrist, is F32.1 - Moderate depressive episode, without psychotic symptoms. **Plan agreed at the CAMHS review** 01/11/2024 * Dr. Emily Carter (Psychiatrist) * Sarah Peterson (Patient) * Mrs. Peterson (Mother) * Dr. Sarah Jenkins (GP) Overview plan: To review and adjust current antidepressant medication, enhance psychological support, and monitor physical and mental health closely. **Medication**: Following discussion, it was agreed to increase Sarah's current Fluoxetine dosage from 20mg daily to 30mg daily. This change will be implemented immediately. Dr. Jenkins, the GP, will issue the new prescription. Sarah and her mother have been advised on potential side effects, including increased anxiety or agitation in the initial weeks, and instructed to contact Dr. Jenkins or the CAMHS team if these become unmanageable. A follow-up telephone consultation with the CAMHS psychiatrist, Dr. Carter, is scheduled for one month's time (01/12/2024) to assess the efficacy and tolerability of the new dosage. If there is no significant improvement or if adverse effects are prominent, alternative antidepressant options or further dosage adjustments will be considered at that time. **Next review**: 01/12/2024. Sarah Peterson, Mrs. Peterson, and Dr. Emily Carter (Psychiatrist) will attend. Any further medication changes to be reviewed then. Physical health monitoring: Sarah is at low risk for Medical Emergencies in Eating Disorders (MEED) at present, but continued monitoring of weight and general physical health remains important given her history of reduced appetite. Her GP, Dr. Jenkins, will conduct a physical health check in two weeks (15/11/2024), including blood pressure, pulse, and weight. Regular monitoring will continue as part of her routine GP appointments, with communication to CAMHS if any concerns arise. Psychological Health Monitoring: We understand you've been finding things incredibly tough, Sarah. We discussed how important it is for you to continue attending your regular psychotherapy sessions and to try to engage with the coping strategies you've been learning. We want to work with you to monitor your mood, sleep, appetite, and your engagement in activities you once enjoyed. Please keep a mood diary, as we discussed, to help us track your progress. If you feel your mood significantly worsens, or if you find yourself having thoughts of self-harm, it's vital that you reach out immediately to your mother, Dr. Jenkins, or the CAMHS crisis line. Your safety is our top priority, and we have a plan in place to support you if you feel you are struggling. We will review your psychological well-being comprehensively at your next appointment, looking at how the medication changes are impacting your overall mental health. Discussion During our meeting today, Sarah, we thoroughly explored your current mental health presentation, including the ongoing low mood, lack of energy, and how difficult social situations have become for you. We talked about the impact these symptoms have had on your daily life, your schooling, and your relationships. We reviewed your current medication, Fluoxetine, discussing both the positive effects you've experienced, such as a slight lift in mood initially, and the adverse effects, specifically the persistent nausea you've reported. We also discussed your experience of depression over time, noting previous periods of low mood in adolescence and how medication has sometimes helped, but not always fully. We explored various options for managing your symptoms, including continuing with your current dosage, increasing it, or trying a different antidepressant. We considered the pros and cons of each approach, ensuring you and your mother had the opportunity to voice your concerns and ask questions. After a detailed discussion, where we focused on your comfort and potential benefits, we jointly agreed that increasing your Fluoxetine dosage was the most appropriate next step at this time, alongside continued psychological support. We want to assure you that this is a collaborative process, and your feedback is crucial in shaping your treatment plan. We also spent time detailing your psychiatric symptoms comprehensively. From a physical level, you described persistent fatigue and some mild headaches. Neurologically, you reported difficulty concentrating and a general mental fogginess. Psychologically, you articulated feelings of hopelessness, worthlessness, and a significant reduction in enjoyment from previously pleasurable activities. Interpersonally, you've withdrawn from friends and family, finding social interactions overwhelming. Cognitively, you've noticed a decline in your ability to focus on schoolwork and recall information. Behaviourally, there has been a marked decrease in your activity levels, often staying in bed longer and struggling to initiate tasks. We agreed the plan as at the top of the letter. Yours sincerely Dr. Emily Carter (GMC: 1234567) cc: * Dr. Sarah Jenkins (GP) * CAMHS Team Coordinator * Mrs. Peterson (Mother)