Recommended Follow-Up Schedule in Psychiatry
For patients starting psychiatric treatment, schedule an initial follow-up within 1 week of treatment initiation, followed by weekly contact during dose titration (2-4 weeks), then monthly visits until symptoms stabilize for 6-12 months after full symptom resolution. 1
Initial Treatment Phase
First Week After Treatment Initiation
- Schedule an in-person assessment within 1 week of starting treatment to monitor for adverse events and assess early response 1
- This is particularly critical when initiating antidepressant medications (SSRIs) in adolescents, where close monitoring for suicidality and behavioral changes is mandated by FDA black-box warnings 1
- Telephone contact may be equally effective as face-to-face visits for monitoring, based on evidence showing high reliability of telephone interviews for depression assessment 1
Titration Phase (Weeks 2-4)
- Maintain weekly contact (by telephone or in-person) during dose adjustment periods 1
- The titration phase typically requires 2-4 weeks for stimulant medications and similar timeframes for antidepressants 1
- At each contact, systematically assess: (1) ongoing symptoms, (2) suicide risk, (3) adverse effects using specific questioning, (4) treatment adherence, and (5) new environmental stressors 1
Maintenance Phase
Monthly Monitoring Until Stabilization
- Schedule appointments at least monthly until symptoms are fully stabilized 1
- Continue monthly monitoring for 6-12 months after complete symptom resolution 1
- For recurrent depression, extend monitoring up to 2 years given high recurrence rates 1
Factors Requiring More Frequent Visits
Increase appointment frequency beyond monthly if: 1
- Significant side effects emerge
- Comorbid psychiatric disorders cause substantial impairment
- Problems with medication adherence occur
- Patient requires additional psychoeducation or psychosocial intervention
Post-Discontinuation Monitoring
After stopping antidepressant medication, provide close follow-up for at least 2-3 months, as the greatest relapse risk occurs within the first 8-12 weeks after discontinuation 1
Special Considerations for Depression Treatment
Follow-Up Timing in Primary Care Settings
- Evidence from provider intervention studies suggests scheduling follow-up within 2 weeks for depression patients significantly improves outcomes (OR 2.23,95% CI 1.26-3.97 for one standardized patient scenario) 1
- Studies examining treatment visits at 12 weeks showed a mean difference of approximately 1.3 fewer visits needed when using computerized decision support systems 1
Critical Pitfalls to Avoid
Do not discharge patients prematurely after initial symptom improvement. The evidence clearly demonstrates that maintaining treatment for 6-12 months after full symptom resolution is necessary for relapse prevention, with some studies showing significantly fewer relapses when medication is continued for 32 weeks versus discontinuation 1
Do not rely solely on patient self-scheduling for follow-up appointments. Scheduling specific outpatient appointments as part of discharge planning significantly increases attendance rates (OR 1.69 for 7-day follow-up, OR 1.65 for 30-day follow-up) compared to asking patients to schedule themselves 2
Do not assume adequate treatment trials without sufficient duration. Each antipsychotic treatment episode requires at least 6 weeks at therapeutic dose to be considered adequate, meaning minimum 12 weeks total treatment before determining treatment resistance 1