Download RELAPSE PREVENTION PLAN

Fax completed log to: 919‐962‐3265 ATTN: CODIACS
Relapse Prevention Plan
ID NUMBER:
0a. Completion Date: /
/
0b. Staff ID: Today’s PHQ9 Score: ____
1. Review the course of symptoms up to now and address the following:
 distress and/or depression symptoms
 impact of the adjustment distress on the patient’s ability to function at home and at work
 current treatment(s) and treatment(s) tried before
 questions about treatment(s)
Notes:
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2. Review risk factors for relapse.
 2 or more prior episodes of depression
 dysthymia: chronic depressive symptoms for 2 years or more
 residual depressive symptoms (patient is not completely back to baseline)
 Remind the patient that these are risk factors for relapse of symptoms. We know from prior research that, without
active treatment, 50% of patients with one prior episode of major depression will have a relapse within two years.
Patients with 2 or 3 prior episodes have a 70 or 90% chance of relapse, respectively.
3. Review the rationale for continuing medication or maintenance PST and encourage the patient to do so.
 Research has shown that full doses of antidepressants (i.e., the doses which resulted in the initial remission of
symptoms) or ongoing maintenance psychotherapy significantly reduce the risk of relapse. For some patients,
medication maintenance treatment may be required indefinitely.
 Get a sense of what might motivate the patient to stay on long-term medication. Reinforce the patient’s motivation
to do so as much as possible.
Notes:
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4. Review any concerns about continuing medications or psychotherapy and anticipate potential barriers.
 Start out with neutral question such as “I wonder how you feel about taking your antidepressant medication long
term?”
 Point out that up to 50 % of patients with chronic medical illnesses have difficulty taking their medications as
prescribed.
 Ask patients to generate a list of pros and cons of staying on medication long term, and to weigh these against
the risks and benefits of stopping antidepressants.
 Patients may have a number of concerns about the long-term use of antidepressants, and it is important to
address these as much as possible. (See Section 5 (E), Commonly Asked Questions Regarding
Antidepressants).
Notes:
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Relapse Prevention Plan Page 1 of 2 5. Discuss early warning signs of distress.
Patients and significant others can learn to recognize such early warning signs and get help before relapses become
severe.
Common early warning signs include changes in sleep, appetite, or energy level, loss of interest in usual activities,
irritability or withdrawal from others. These early warning signs differ from patient to patient. Patients or significant
others may remember early signs of distress from their most recent episode.
In many cases, spouses or significant others may notice such warning signs before a patient does, and it can be very
helpful to involve them in the monitoring for such signs.
Notes:
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6. Make a relapse prevention plan.
It can be very discouraging to experience a recurrence of symptoms. If patients detect these symptoms early on,
however, it may be easier to prevent a severe relapse.
Encourage patients to think positively about seeking additional help for symptoms. Seeking such help should not be
seen as a sign of failure, but as a positive step (i.e., “I am doing something to take care of myself”).
A relapse prevention plan for the patient includes early warning signs and a plan for what to do if you or a significant
other notices such symptoms.
Relapse Prevention Plan
(check all that are discussed):
 discussing the situation with a close friend/relative
 making sure you are taking the medication as prescribed
 considering stressful life situations (problems at work, in one’s family, etc.) which may lead to an exacerbation of
symptoms and using the skills learned in PST to address them
 scheduling positive life events
 contacting the ADS
 contacting the cardiologic care provider or a psychotherapist who has been helpful in the past
Note:
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7. Discuss future clinic or telephone follow-up contacts.
 once per month
st
 date of 1 maintenance call: _________________________________________
8. Remind patients that both you and the cardiologic care provider are available and how you can be reached.
Note:
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Relapse Prevention Plan Page 2 of 2