Plenty of people are on psychiatric medication that nobody has properly looked at for years. A tablet was started during a bad patch, the dose was nudged once or twice, another was added, and the whole arrangement carried on because changing it felt more dangerous than leaving it alone.
A medication review is a single appointment that steps back from that and asks the awkward questions. Is each medicine still doing something? Is what it is doing worth what it costs you? Is the diagnosis it was prescribed for still the best explanation? This page explains when paying for one is justified, what actually happens in it, and where its limits are.
When a review is worth paying for
Not everyone needs a specialist. If your medicine is working and you feel fine, a GP review is the right level of care. These are the situations where a consultant psychiatrist adds something a GP appointment usually cannot.
Nothing has changed after a fair trial
The commonest reason to book. You have taken a medicine at a proper dose for long enough to know, and you feel much the same. A psychiatrist can judge whether the trial was genuinely adequate, whether the dose was ever optimised, and which of switching, augmenting or changing class makes most sense next.
The side effects are the problem
Sedation, weight gain, emotional flatness, sexual side effects, tremor. The NHS notes that many side effects ease after a couple of weeks as your body adjusts — but some do not, and living with them indefinitely is a choice, not an inevitability. There are usually alternatives.
You are on several medicines at once
Two antidepressants, a mood stabiliser, something for sleep, something added for anxiety. Each addition may have been reasonable at the time, but the combination can end up doing less than a simpler one would, with more side effects and more interactions. Untangling that is specialist work.
You are no longer sure the diagnosis is right
If treatment for depression has repeatedly not worked, one possibility is that the treatment is wrong and another is that the diagnosis is. Unrecognised ADHD, bipolar disorder, anxiety as the primary problem, or the effects of trauma can all look like treatment-resistant depression. Diagnostic clarification is part of what a psychiatric assessment is for.
You want to come off
Wanting to stop is a legitimate reason to see a specialist rather than something to be talked out of. What you need is a plan and someone reviewing it, not a decision made alone on a Sunday night.
What counts as a fair trial
This is worth getting right, because people abandon medicines that were never given a chance, and persist with ones that were never going to work.
The NHS says antidepressants usually take 1 to 2 weeks to start having an effect and can take up to 8 weeks to work fully — see the NHS page on antidepressants. NICE’s depression guideline goes further on the other side: if depression has not responded at all after four weeks of antidepressant medication at a recognised therapeutic dose, that should prompt a discussion about barriers and whether the medicine is being taken as prescribed.
So a fair trial means an adequate dose, taken consistently, for long enough. If any of those three were missing, the honest conclusion is that the medicine has not been tested yet. On duration once things improve, the NHS says antidepressants are usually taken for at least six months after you feel better, and NICE says treatment should be reviewed regularly rather than simply repeated.
Planning a pregnancy, or already pregnant
This deserves its own appointment and often more than one opinion.
NICE’s guideline on antenatal and postnatal mental health says that before starting any treatment in pregnancy or the postnatal period, clinicians should discuss the higher threshold for medication arising from the changed balance of benefit and risk, and the likely benefits of a psychological intervention. It also says to discuss the risk or harm to the woman and the baby associated with stopping or changing a treatment — stopping is a decision with its own risks, not a neutral default.
Critically, NICE says clinicians should seek more detailed advice from a secondary mental health service, preferably a specialist perinatal mental health service, and should consider referral for preconception counselling where there is a current or past severe mental health problem. Happy Clinic’s psychiatrists can review your medication and set out the questions, but a specialist perinatal opinion may be needed, and you should expect to be told so rather than reassured out of it.
What happens in the appointment
A medication review at Happy Clinic is a 60-minute initial psychiatric assessment by secure video with a GMC-registered consultant psychiatrist. Consultations are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC). Adults aged 18 and over, anywhere in the UK, and no GP referral is needed.
In the hour, the psychiatrist will normally:
- build a full medication history — everything tried, at what dose, for how long, what happened and why each was stopped
- reassess the diagnosis rather than assuming the one on your notes
- separate side effects from symptoms, which is harder than it sounds and frequently the crux
- check physical health factors and other medicines that bear on what can safely be prescribed
- ask what you want, because a plan you do not believe in will not be followed
- agree a written plan, with what to do if it does not work
Bring a list. Names, doses, start and stop dates, and any allergies or bad reactions. It is worth more than any other preparation.
What might change afterwards
Sometimes a great deal, sometimes nothing. The realistic outcomes:
| Outcome | What it means |
|---|---|
| Dose optimised | The right medicine, never pushed to an effective dose |
| Switch | A different medicine, usually with a cross-taper plan |
| Simplify | Stopping something that is no longer earning its place |
| Add | A second agent where one is partly working |
| Taper and stop | A staged reduction with review points |
| Revised diagnosis | A different condition, and a different treatment path |
| No change | The current prescription is right, and something else needs attention |
That last row matters. “No change, and here is why” is a legitimate and useful result, and often comes with advice that the missing piece is therapy rather than medication.
Why changing things yourself is the real risk
Stopping abruptly is the most common way this goes wrong. The NHS is blunt: do not stop taking an antidepressant suddenly or without talking to your doctor first, and it describes withdrawal effects including headaches, nausea, sweating, dizziness, sleep problems and the odd electric-shock sensations often called brain zaps. Instead, a plan is agreed to reduce the dose gradually, usually over several weeks or months.
NICE’s depression guideline describes reducing the dose to zero in steps, at each step prescribing a proportion of the previous dose, and notes that withdrawal symptoms occur with a wide range of antidepressants including tricyclics, SSRIs and SNRIs. Its guideline on medicines associated with dependence or withdrawal symptoms applies the same collaborative approach to benzodiazepines, Z-drugs, gabapentinoids and opioids as well as antidepressants. The Royal College of Psychiatrists also publishes patient information on stopping antidepressants.
The practical danger of doing it alone is not only withdrawal. It is that withdrawal effects and returning illness look alike, and telling them apart needs someone who knows what to expect and when.
How your GP is kept informed
With your consent, a clinical summary goes to your GP setting out what was decided and why. This is not a courtesy. GMC guidance says that when an episode of care is completed a doctor must tell the patient’s GP about changes to medicines and the reasons, the length of intended treatment, monitoring requirements and any new adverse reactions identified.
You can decline. The GMC says that where a patient refuses consent to share, the risks of not sharing should be explained and documented — and that where safety would be compromised, the doctor may not be able to prescribe at all. In practice, keeping your GP informed is what makes it possible for them to continue a prescription later. How prescriptions work afterwards is set out separately.
Second opinions: what they can and cannot settle
A second opinion is a fresh assessment by a different consultant. It can confirm the existing diagnosis and treatment, which is reassuring and closes the question. It can revise the diagnosis. It can propose something not yet tried. Or it can say the picture is genuinely uncertain and explain what would clarify it.
What it cannot do is overrule anyone. No consultant can compel your GP or an NHS team to adopt their view, and a second opinion is not a document for tribunals or employers — Happy Clinic does not write medico-legal or benefits reports. Getting a third opinion after a second usually tells you more about how hard the problem is than about who is right.
Costs, and what is not included
An initial psychiatric assessment, which is the appointment used for a medication review, is £400 for 60 minutes. Follow-ups are £200 for 20 minutes. Fees are paid in advance. Any prescription issued during an appointment is included in the fee; what the pharmacy charges for the medicine is not. Fees checked September 2026 — see the fees page for the current list.
Happy Clinic does not provide psychological therapy, does not see under-18s, and is not a crisis service. If a life is at risk, call 999 or go to A&E. For urgent mental health help, call NHS 111 and choose the mental health option in England, or see the NHS page on where to get urgent help. Samaritans are on 116 123, free, at any hour.
If you want to go ahead, book an appointment, or read what to expect at your first appointment first.
Speak to a Consultant Psychiatrist
Book a secure video consultation with Happy Clinic, for adults aged 18 and over anywhere in the UK. No GP referral is needed and appointments are often available within days.
This page is general information and is not a substitute for personal medical advice. Consultations, diagnosis and prescriptions are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC). If you are in crisis, call 999, go to A&E, call NHS 111 or call Samaritans free on 116 123.