Treatment chart instructions

The purpose of the following Treatment Chart is to provide your doctor or therapist with a record of all treatment you have undergone to manage your depression to date. Instructions
Prior to your appointment, please complete the Treatment Chart attached to this instruction page. Please provide as much information about the different types of treatment (including psychological interventions such as counselling, or psychotherapy and/or anti-depressant medications, or electro-convulsive therapy - ‘ECT’): you have had over the years, or are currently undergoing, and how helpful you think each treatment has been. To assist you in completing your own Treatment Chart, we have included: Sample Only
TREATMENT CHART
Medication
Duration
Effective?
Reason for stopping
Commenced
Had been well for some time so stopped taking it Psychological
Sessions
Effective?
Why stopped
Commenced
Number of
Effective?
Why stopped
Commenced
treatments
This document may be freely downloaded and distributed on condition no change is made to the content. The information in this document is not intended as a substitute for professional medical advice, diagnosis or treatment. Not to be used for commercial purposes and not to be hosted electronically outside of the Black Dog Institute website.
Medication
Duration
Effective?
Reason for stopping
Commenced
Psychological
Sessions
Effective?
Why stopped
Commenced
Number of
Effective?
Why stopped
Commenced
treatments
This document may be freely downloaded and distributed on condition no change is made to the content. The information in this document is not intended as a substitute for professional medical advice, diagnosis or treatment. Not to be used for commercial purposes and not to be hosted electronically outside of the Black Dog Institute website.
TREATMENT LIST
This list may help you to remember any treatments you may have tried for depression. The drug name is followed by different brand names. Antidepressants
Mood Stabilisers
Sedative-Hypnotics
AMITRIPTYLINE / Endep / Tryptanol / Tryptine / Amitrol
CARBAMAZEPINE / Tegretol / Teril / Carbium
ALPRAZOLAM / Xanax / Kalma / Ralozam
CITALOPRAM / Cipramil
GABAPENTIN / Neurontin
ATIVAN / Lorazepam
CLOMIPRAMINE / Anafranil / Placil
LAMOTRIGINE / Lamictal
BUSPIRONE / Buspar
DESIPRAMINE / Pertofran
LITHIUM CARBONATE / Lithicarb / Quilonum SR
CLOBAZAM / Frisium
DOTHIEPIN / Prothiaden / Dothep
SODIUM VALPROATE / Epilim / Valpro
CLONAZEPAM / Rivotril
DOXEPIN / Sinequan / Deptran
TOPIRAMATE / Topamax
DIAZEPAM / Valium / Ducene / Antenex
FLUOXETINE / Prozac /Zactin /Lovan /Auscap /Erocap /Fluohexal
Antipsychotics
FLUNITRAZEPAM / Rohypnol / Hypnodorm
FLUVOXAMINE / Luvox / Faverin
AMISULPRIDE / Solian
NITRAZEPAM / Alodorm / Mogadon
IMIPRAMINE / Tofranil / Melipramine
ARIPIPRAZOLE / Abilify
OXAZEPAM / Serepax / Murelax / Alepam
MIANSERIN / Tolvon / Lerivon / Lumin
CHLORPROMAZINE / Largactil
STILNOX / Zolpidem
MIRTAZAPINE / Avanza / Remeron
CLOPIXOL / Clopixol
TEMAZEPAM / Normison / Temtabs / Euhypnos / Temaze / Nocturne
MOCLOBEMIDE / Aurorix / Arima / Mohexal
CLOZAPINE / Clopine / Clozaril
ZOPICLONE / Imovane
NEFAZODONE / Serzone
DROPERIDOL / Droleptan
NORTRIPTYLINE / Allegron
FLUPENTHIXOL / Fluanxol Depot
Psychological Therapies
PAROXETINE / Aropax
FLUPHENAZINE / Modecate / Anatensol
COUNSELLING
PHENELZINE / Nardil
HALOPERIDOL / Serenace / Haldol Decanoate
COGNITIVE BEHAVIOURAL THERAPY
SERTRALINE / Zoloft
OLANZAPINE / Zyprexa
GROUP THERAPY
TRANYLCYPROMINE / Parnate
ORAP / Pimozide
RELATIONSHIP/COUPLES THERAPY
NB. Please include any other specific psychological therapies you
TRIMIPRAMINE / Surmontil
PERICYAZINE / Neulactil
may have had (eg. grief therapy, assertiveness training, gestalt therapy, psychodynamic therapy etc.) VENLAFAXINE / Efexor / Efexor-XR
PROMAZINE / Sparine
QUETIAPINE / Seroquel
RISPERIDONE / Risperdal
THIORIDIAZINE / Aldazine / Melleril
THIOTHIXENE / Navane
TRIFLUOPERAZINE / Stelazine
This document may be freely downloaded and distributed on condition no change is made to the content. The information in this document is not intended as a substitute for professional medical advice, diagnosis or treatment. Not to be used for commercial purposes and not to be hosted electronically outside of the Black Dog Institute webs ite.

Source: http://www.blackdoginstitute.org.au/docs/PatientTreatmentChart.pdf