Almost every question people ask before starting treatment is about the first appointment. Hardly anyone asks about the weeks afterwards – which is odd, because that is where most of the work happens. A consultation sets a direction; the gaps between consultations are where a medicine starts working, a side effect shows up, or a plan turns out to need changing.
How often follow-ups happen, and why it varies
There is no fixed timetable. The interval is a clinical judgement, and it reflects how much is changing.
| Where you are | Typical rhythm | Why |
|---|---|---|
| Starting a new medicine | Within the first month | Side effects and early response both show up here |
| ADHD titration | A review at each dose step | Every increase needs its own check |
| Settled on treatment | Every few months, then annually | Less is changing, so less frequent review is safe |
| Something new has happened | Sooner, by arrangement | The plan may need to change |
For ADHD specifically, the National Institute for Health and Care Excellence recommends in its guideline NG87 that ADHD medication be reviewed at least once a year by a professional with training and expertise in ADHD. Annual review is a floor, not a target – most people are seen more often while a dose is being found.
If you are unsure when your next appointment should be, ask at the end of the current one and write the answer down.
What monitoring means in practice
“Monitoring” sounds institutional. It is really a short list of numbers, mostly gathered by you.
Physical checks for ADHD medication. Stimulants and some non-stimulants affect heart rate and blood pressure, so both are tracked. NICE guideline NG87 advises monitoring heart rate and blood pressure before and after each dose change and every six months, and measuring weight every six months in adults. In practice you will be asked to:
- take your blood pressure and pulse at home with an upper-arm monitor, noting readings with dates;
- weigh yourself at roughly the same time of day, on the same scales;
- bring both to your review.
A home monitor is the practical option, because you need readings repeatedly and at your own convenience. Pharmacies can also check blood pressure – the NHS runs a free blood pressure check service in England – but that service is aimed at people aged 40 and over without an existing diagnosis of high blood pressure, so it will not cover everyone.
Blood tests arranged locally. Some medicines need blood tests – checks on kidney, liver or thyroid function, or drug levels for certain mood stabilisers. A video appointment cannot take blood. Instead, your psychiatrist specifies which tests are needed and why, and the blood is taken locally: usually through your GP practice, sometimes through a private phlebotomy service. Results are reviewed at your appointment. Plan this ahead, because a test that has not been done can hold up a dose change.
Symptom tracking. This is the part people underestimate. Memory smooths things out, and by week six it is hard to recall whether sleep improved before or after the dose went up. A few words a day is enough: mood out of ten, hours slept, whether you took the medicine, anything unusual.
If something changes before your next appointment
Changes fall into three groups, and they need different responses.
Urgent and physical. Chest pain, fainting, a spreading rash, a suspected allergic reaction or severe agitation are not things to save for a routine review. Contact NHS 111, your GP urgently, or in an emergency call 999.
Urgent and psychological. If you are in crisis or at risk, this site is not the route. If a life is at risk, call 999 or go to A&E. For urgent mental health help, call NHS 111 and, in England, choose the mental health option – NHS 111 online covers England, with NHS 24 on 111 in Scotland and 111 in Wales. Samaritans are on 116 123, free, 24 hours a day. The NHS lists fuller routes on its page on where to get urgent help for mental health.
Troubling but not urgent. A side effect you can tolerate, a dose that does not seem to be doing much, a question about alcohol or another medicine. Report these rather than sitting on them, because they often change the plan. Email or phone the clinic and ask for clinical advice or an earlier appointment.
What not to do is stop a medicine quietly and mention it at the next review. That leaves your clinician interpreting three months of data describing something other than the treatment they think you are on.
Safety-netting, explained
When a clinician talks about safety-netting, they mean the part of the plan covering what happens if things do not go as expected. It has three parts, and you should be able to repeat all three after an appointment:
- What to look out for – the specific symptoms or changes that matter, named rather than implied.
- What to do about each – wait and see, contact the clinic, contact your GP, or seek urgent help.
- When to act – a timeframe, such as “if sleep has not settled within two weeks” rather than “if it carries on”.
Safety-netting is not a formality; it is how remote care stays safe between contacts. The General Medical Council’s guidance on remote consultations is clear that the standards of good practice apply equally to remote and face-to-face care. If a plan was explained quickly and you did not catch it, ask for it in writing. It should also appear in your clinical summary – see how it works.
Getting a question answered without a full appointment
Not everything needs 20 minutes of a consultant’s time. Clinics handle three kinds of contact differently:
- Administrative questions – appointment times, invoices, joining the call – go to the support team. Happy Clinic can be reached on +44 (0)330 133 0855 or support@happyclinic.co.uk, 11am to 7pm Monday to Friday.
- Brief clinical questions your psychiatrist can answer from your record are passed on and answered when the clinician next reviews messages. That is not immediate, and not a substitute for urgent help.
- Anything needing a decision – a dose change, a new medicine – needs an appointment, because the clinician has to assess before acting.
For existing patients who are stable, a repeat prescription request can sometimes be handled without a full consultation: Happy Clinic charges £150 for this, subject to clinical review, and the clinician can decline if a review is needed instead (fees checked September 2026 — see the fees page). The guide to prescriptions after an online consultation covers what is included.
Making a 20-minute follow-up count
A follow-up is short by design. It is a review, not a repeat assessment, and it typically covers: how you have been, side effects, your monitoring figures, whether the dose or medicine should change, and when you will be seen again. Twenty minutes is enough for that if the groundwork is done.
Three things help most:
- Have your numbers ready – readings, weight, dates – rather than hunting for them during the call.
- Lead with the most important thing. Say it in the first two minutes, not the last two.
- Write your questions down beforehand, and read them out if you go blank. The preparation that helps at a first appointment helps here, in miniature.
If the appointment needs to cover a lot – a new problem as well as a medication review – say so when you book, so time can be allocated properly.
If you want to stop or change your medication
Wanting to stop is common and entirely reasonable to raise. What matters is how you do it.
For antidepressants, the NHS is direct: do not stop taking an antidepressant suddenly or without talking to your doctor first. Doses are normally reduced gradually, over weeks or months, because stopping abruptly can cause withdrawal effects including headaches, nausea, disturbed sleep, dizziness and unusual sensations. The NHS page on stopping or coming off antidepressants sets out what to expect.
Other medicines behave differently. Stimulants for ADHD do not need tapering in the same way, but stopping changes how your day works, so it is worth planning rather than improvising. Some medicines need a switch rather than a stop.
Bring the question to a review, be honest about the reason – side effects, cost, feeling better, or being tired of taking tablets – and expect a plan rather than a verdict. If prescribing has moved to your NHS GP under a shared care agreement, talk to whoever is prescribing now, and make sure the other party is told what was decided.
Questions about your own care belong with your clinician. For general questions about how video appointments run, see the FAQ.
This article is general information, not personal medical advice. If you are worried about your mental health, speak to a doctor. In a crisis call 999 or NHS 111.
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