Depression consultation

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This service is for people who are already taking an antidepressant and want to continue the same medicine at the same dose. It isn’t for starting a new antidepressant, changing your dose, or urgent help. If you need urgent support, please see the crisis contacts on the last page.

Name *

First

Last

Date of birth *

Email *

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Are you aged 18 or over? *

This service is for adults aged 18 and over. For under-18s, antidepressants need to be managed by a GP or a specialist. Please contact your GP. If you need urgent help, call NHS 111 (mental health option) or the Samaritans free on 116 123.

Do you believe you have the mental capacity to make decisions about your own healthcare? *

We’d like to talk this through with you first. Please contact your GP, or us at info@courierpharmacy.co.uk.

Which antidepressant are you currently taking? *

Citalopram
Duloxetine
Escitalopram
Fluoxetine
Sertraline
None of these

This service is for continuing one of the antidepressants listed. As you’re not currently taking one of these, please speak to your GP, who can review your treatment.

What dose of antidepressant are you currently taking? *

Have you taken this medicine at this dose, most days, for at least the last 4 weeks? *

Yes
No – my dose changed in the last 4 weeks
No – I’ve missed a week or more recently
Not sure

As your dose has changed recently, we’re unable to process your request through our service at this time. Please get in touch with your GP, who will be best placed to manage your prescription going forward.

As you’ve missed a week or more of your medication recently, we’re unable to continue through our service at this time. Please speak to your GP, who can safely review how best to restart or continue your treatment. Please don’t restart a changed routine without advice.

As you’re not sure whether you’ve been taking your medication regularly, we’re unable to continue through our service just now. Please speak to your GP, who can review your treatment with you.

If you were struggling with your mood or were thinking of harming yourself, which of these are you able and willing to contact? *

A friend, relative or work colleague
NHS 111
My NHS GP
999
A charity support service like the Samaritans
Nobody

We’re unable to process your request through our service at this time. To make sure you’re fully supported, we’d recommend speaking with your GP, who can ensure the right care and support is in place for you. You can also call NHS 111 (mental health option) or the Samaritans free on 116 123 at any time.

Over the last 2 weeks, how often have you been bothered by: thoughts that you would be better off dead, or of hurting yourself in some way? *

Not at all
Several days
More than half the days
Nearly every day

Please reach out for support today. Thank you for answering honestly – that takes real courage. Because you’ve told us you’ve been having these thoughts, an online repeat service isn’t the right way to keep you safe just now, and you deserve proper support from someone who can be there with you.

Please talk to someone today:
• Call NHS 111 and choose the mental health option
• Call the Samaritans free on 116 123 – any time, day or night
• Contact your GP
• If you feel unable to keep yourself safe, call 999 or go to A&E now.

You don’t have to face this on your own.

Bipolar Disorder (sometimes called “Manic Depression”) is where you have periods of higher-than-normal mood and hyperactivity in between episodes of low mood. A milder form is called Cyclothymia.

Have you ever been diagnosed with Bipolar Disorder or Cyclothymia? *

No
Yes – now or in the past

We are unable to provide medication for mood disorders to people with a history of Bipolar Disorder. This is because the usual medications for depression can cause a person with bipolar to have an unstable mood. Please see your GP or mental health service about your medications. In a crisis, call NHS 111.

Since being on this medication, has there ever been a period of time – lasting at least 3 days – when you felt so good, high, or full of energy that other people thought you were not your usual self, or you got into trouble? *

No
Yes – one or more episodes lasting at least 3 days

We are unable to continue with your request through our service at this time. What you’ve described may need further assessment for bipolar disorder or emotionally unstable personality disorder (EUPD) before this treatment can be safely prescribed. Please speak with your GP, who can review your symptoms and refer you for the right support.

Are you experiencing any of these right now? (tick all that apply) *

Very restless / can’t keep still
Confused or muddled unusually
Very frequent muscle twitching
Muscle shaking or stiffness
Fast or pounding heartbeat with no cause
Heavy sweating
A high temperature above 39.0°C
None of these

The symptoms you’ve described need urgent medical attention. Please stop taking this treatment and go to your nearest emergency department or call 999 immediately. Do not wait for a GP appointment.

Are you currently taking, or have you taken in the last 2 weeks, any of these? (tick all that apply) *

Tramadol
An MAOI for depression (phenelzine, tranylcypromine, isocarboxazid, moclobemide)
Antipsychotics (quetiapine, olanzapine, risperidone, aripiprazole, haloperidol, clozapine, amisulpride, pericyazine)
Mood stabilisers (valproate, lamotrigine, carbamazepine, oxcarbazepine)
Benzodiazepines or sleeping tablets (zopiclone, diazepam, temazepam, lorazepam, nitrazepam, clonazepam, alprazolam, zolpidem)
St John’s Wort
A blood thinner (warfarin, apixaban, rivaroxaban, clopidogrel or daily aspirin)
Anti-inflammatory tablets on most days (e.g. ibuprofen, naproxen, meloxicam, diclofenac)
Linezolid (an antibiotic)
Pimozide
None of the above

Some of the medicines you’ve selected can interact seriously with your antidepressant and need a doctor’s review before continuing. Please speak to your GP, who can check this safely.

Some of the medicines you’ve selected can interact with your antidepressant – for example a higher chance of bleeding, or added drowsiness. Our prescriber will review this before continuing.

Have you ever been told you have a long QT interval, or congenital long QT syndrome (a heart-rhythm condition)? *

Yes
No
Not sure

Citalopram and escitalopram are not used where there’s a long QT interval or congenital long QT syndrome, as they can affect the heart’s rhythm. We can’t continue through our service – please speak to your GP, who can review a suitable alternative. Don’t stop your medication suddenly.

Are you taking any medicines that can affect the heart's rhythm (the QT interval)? For example: antiarrhythmics (amiodarone, sotalol, flecainide, propafenone); antipsychotics (pimozide, haloperidol, or a phenothiazine); a tricyclic antidepressant; some antibiotics (moxifloxacin, IV erythromycin); antimalarials (halofantrine); or certain antihistamines. *

Yes
No
Not sure

Citalopram and escitalopram must not be combined with other medicines that affect the QT interval, as together they can seriously affect the heart’s rhythm. We can’t continue through our service – please speak to your GP.

As citalopram and escitalopram can affect the QT interval, our prescriber will check this carefully before continuing.

Are you taking any of these: omeprazole, esomeprazole, lansoprazole, fluconazole, fluvoxamine, ticlopidine, or cimetidine? *

These medicines can raise the level of citalopram or escitalopram in your body, so the prescriber may need to adjust your dose. They’ll review this before continuing.

Are you taking tamoxifen? *

Fluoxetine can reduce how well tamoxifen works, so the two should be avoided together. We can’t continue through our service – please speak to your GP, who can review a suitable alternative.

Are you taking any of these: flecainide, propafenone, metoprolol, atomoxetine, risperidone, carbamazepine, phenytoin, or a tricyclic antidepressant (e.g. amitriptyline, nortriptyline)? *

Yes
No
Not sure

Fluoxetine can raise the levels of these medicines (and can affect phenytoin), so our prescriber will review this carefully before continuing.

Fluoxetine stays in the body for a long time after the last dose, which affects how it’s changed or stopped – your prescriber will bear this in mind.

Are you taking fluvoxamine, ciprofloxacin, or enoxacin? *

Duloxetine must not be taken with fluvoxamine, ciprofloxacin or enoxacin, as they raise duloxetine to unsafe levels. We can’t continue through our service – please speak to your GP.

Do you have high blood pressure that isn't well controlled? *

Yes
No
Not sure

Duloxetine can raise blood pressure, so it isn’t started when blood pressure isn’t well controlled. Please have your blood pressure reviewed by your GP before continuing.

Has a doctor ever told you that you have any of these? (tick all that apply) *

Heart disease
Liver problems
Kidney problems
Epilepsy or seizures
None of these

Antidepressants can lower the seizure threshold, so with epilepsy or a seizure disorder your treatment needs to be managed by your GP. We’re unable to continue through this service – please speak to your GP, and don’t stop your medication suddenly.

Citalopram and escitalopram can affect the heart’s rhythm (the QT interval), so they need careful assessment when there’s heart disease. We’re unable to continue through our service – please speak to your GP, who may suggest a safer alternative. Don’t stop your medication suddenly.

Because you’ve told us about heart disease, our prescriber will review this carefully before continuing your treatment.

Duloxetine isn’t used when there’s liver disease, as it’s processed by the liver. We’re unable to continue through our service – please speak to your GP, who can review a suitable alternative. Don’t stop your medication suddenly.

Because you’ve told us about a liver problem, our prescriber will review this carefully, as it can affect how your medicine is handled by the body.

Duloxetine isn’t used when kidney function is significantly reduced (severe kidney impairment is a contraindication). As we can’t confirm your kidney function here, we’re unable to continue through our service – please speak to your GP, who can check this. Don’t stop your medication suddenly.

Are you getting any side effects from your antidepressant medication? *

I’ve not noticed any side effects
I have mild side effects, but I want to continue
The side effects are affecting my daily life, but I want to continue
I want to stop or change to something else because of side effects

Because your side effects are affecting your daily life, or you’d like to stop or change your treatment, this needs a proper review that we can’t do through this repeat service. Please speak to your GP, who can review your medication and talk through the options with you. Please don’t stop your medication suddenly.

Are you currently pregnant, trying to conceive, or were you pregnant in the past 12 months? *

No
Yes – currently trying to conceive
Yes – currently pregnant
Yes – pregnant within the past 12 months

Antidepressant treatment around pregnancy, breastfeeding, or when trying to conceive needs to be managed by your GP or specialist, who can weigh up what’s safest for you and your baby. Please don’t stop your medication suddenly – speak to your GP.

Please list all the medicines you are currently taking, including supplements and herbal medicines – even if they don't seem relevant. If none, write “none”. *

Have you been diagnosed with any other medical or mental health conditions? Include anything you see your GP for, take medication for, have been to hospital for, or any past operations. If none, write “none”. *

Over the last 2 weeks, how often have you been bothered by the following problems? These questions (the PHQ-9 and GAD-7) help us understand how you’re doing.

Low mood (PHQ-9)

Little interest or pleasure in doing things *

Not at all
Several days
More than half the days
Nearly every day

Feeling down, depressed, or hopeless *

Not at all
Several days
More than half the days
Nearly every day

Trouble falling or staying asleep, or sleeping too much *

Not at all
Several days
More than half the days
Nearly every day

Feeling tired or having little energy *

Not at all
Several days
More than half the days
Nearly every day

Poor appetite or overeating *

Not at all
Several days
More than half the days
Nearly every day

Feeling bad about yourself – or that you are a failure, or have let yourself or your family down *

Not at all
Several days
More than half the days
Nearly every day

Trouble concentrating on things, such as reading or watching television *

Not at all
Several days
More than half the days
Nearly every day

Moving or speaking so slowly that other people could have noticed – or the opposite, being so fidgety or restless that you've been moving around a lot more than usual *

Not at all
Several days
More than half the days
Nearly every day

Anxiety (GAD-7)

Feeling nervous, anxious, or on edge *

Not at all
Several days
More than half the days
Nearly every day

Not being able to stop or control worrying *

Not at all
Several days
More than half the days
Nearly every day

Worrying too much about different things *

Not at all
Several days
More than half the days
Nearly every day

Trouble relaxing *

Not at all
Several days
More than half the days
Nearly every day

Being so restless that it's hard to sit still *

Not at all
Several days
More than half the days
Nearly every day

Becoming easily annoyed or irritable *

Not at all
Several days
More than half the days
Nearly every day

Feeling afraid, as if something awful might happen *

Not at all
Several days
More than half the days
Nearly every day

Are you registered with a GP practice in the UK? *

Please enter your GP practice name *

Please enter your GP practice address / postcode *

Can we contact your GP about your condition and treatment? We'd send a brief note about any treatment prescribed, to keep your records up to date. This doesn't affect your treatment with us. *

Important information about your depression treatment

When to seek urgent help

If you develop thoughts of harming yourself, feel unable to keep yourself safe, or are making plans to end your life, this is an emergency:

Call 999 or go to A&E immediately if you are in immediate danger
Call NHS 111 and select the mental health option for urgent support
Call the Samaritans on 116 123 at any time, day or night
Do not wait for your medication to “start working” if you feel unsafe

Warning signs your depression may be worsening

Contact your GP or seek urgent help if you notice new or worsening thoughts of suicide or self-harm; sudden agitation or restlessness; severe or new anxiety or panic; dramatic mood changes; feeling detached from reality; or hearing or seeing things that others do not.

Younger adults

If you are aged 18–25, antidepressants can sometimes temporarily increase suicidal thoughts when starting or changing dose. This doesn’t happen to everyone, but seek urgent help immediately if it occurs.

Serious side effects – seek urgent medical help

Stop the medication and seek urgent advice if you experience a severe allergic reaction (facial or throat swelling, difficulty breathing, widespread rash); severe chest pain or fainting; seizures; severe confusion, high fever, heavy sweating, shaking, muscle stiffness or agitation (possible serotonin syndrome); unusual bleeding or bruising; or yellowing of the skin or eyes. These are rare but need immediate assessment.

Symptoms needing prompt GP review

Contact your GP if you notice new hallucinations; extremely elevated mood or little need for sleep; severe agitation or aggression; significant worsening of insomnia; or persistent sexual dysfunction that concerns you.

Common side effects (usually not dangerous)

Mild side effects are common when starting or increasing antidepressants and often improve within 1–2 weeks: nausea, headache, dry mouth, sweating, dizziness, sleep changes, sexual difficulties, and mild jitteriness at the start. If mild, continue and monitor; if severe or persistent, contact your GP or our pharmacist.

Important things to know

Antidepressants usually take 2–6 weeks to show full benefit
Do not stop suddenly without medical advice – this can cause withdrawal symptoms
If you miss a dose, take it when you remember unless it’s nearly time for the next – don’t double up
Avoid combining with other medicines (including tramadol or St John’s Wort) without medical advice
Alcohol can worsen depression and increase side effects
If you feel drowsy, dizzy or impaired, do not drive

Follow-up

If your medication is changed you may need a review within 1–2 weeks. Regular monitoring helps keep treatment safe and effective.

Confirmation *

I understand: I know when and how to seek urgent help, I understand the possible side effects, and I agree to seek medical advice if concerning symptoms occur.

Please confirm you agree to the following

You are over the age of 18.
This treatment is for your use only.
You have the capacity to make decisions about your own healthcare.
You have understood all the questions and have answered this consultation truthfully and completely.
You will read the patient information leaflet supplied with this medication.
You understand our system will first validate that you are over 18 before processing your order, including checks against national databases such as the electoral roll.
You understand the clinical team will take your answers in good faith, and that incorrect information can be hazardous to your health.
You understand the clinical and pharmacy team may need to check your Summary Care Record (your NHS GP records) to prescribe safely, and you consent to this where it is clinically appropriate.
You understand we may contact your GP if you have provided their details.
You accept that medication cannot be refunded once it has left our pharmacy.
You will contact us and inform your GP if you experience any side effects, or if there are any changes to your health.
You have read, understood and agree to abide by our terms and conditions of website use, terms and conditions of sale, privacy policy, delivery, refund policy, and cookie policy.

Confirmation *

I agree to all of the statements above.

Do you consent to us accessing your NHS Summary Care Record where clinically appropriate? *

PHQ-9 total (clinician use)

GAD-7 total (clinician use)

Product Category

Important

We review all orders to ensure you receive the best treatment possible. If what you ordered is unsuitable, we will refund part or all of your order.

If we decide that what you ordered is unsafe for you, based on the other information you provided, we won’t provide any treatments. However, we may call you and suggest alternatives.