It's very important when you prescribe antidepressants to make sure you have a plan for assessing response, monitoring for side effects, and deciding about dose adjustments or medication changes. In addition, you may need more frequent contact with your patient during the first few weeks to make sure that symptoms don't worsen to the point that other interventions are needed before the antidepressants start to take effect.

There are several ways of assessing a patient's response to antidepressants. Using a screening instrument at each visit is an effective and easy way to assess response. A reduction in scores on the BDI would indicate improvement. It is important to be systematic in your approach as "clinical feel" can be misleading. Another approach is to have patients rate their mood, energy, or other symptoms on a scale of 1 to 10, or you can evaluate the patient's level of participation in their usual activities (a measure of hedonic/pleasurable drive). Be sure to follow these indicators over the course of treatment.

Now that William has been taking medication for 2 weeks, I am going to meet with him for our scheduled office visit so that we can discuss how the medication is working. William has already taken the BDI, and his score was 16. Also, his response to question 9 was 0, "I don't have any thoughts of killing myself." However, it is still important that I talk with William about any concerns or side effects he may be having.