Spectrum Health Template - Relapse Prevention Plan printable pdf download

Spectrum Health Template - Relapse Prevention Plan

Spectrum Health Template

Relapse Prevention Plan

A Relapse Prevention Plan focuses on stress reduction and self-monitoring and can help

you to recognize depression early.

Patient Name:

Today’s Date:

Program activation date:

Contact/Appointment information

Primary Care Provider:_____________________________________________

Next appointment: Date:__________________________________Time:____

Care Manager:________________________ Telephone number:__________

Next Appointment:_________________________ (circle one-6 mo/12mo follow up call)

**Use the depression-fighting strategies that have worked for you in the past, including

taking your antidepressant medication regularly, increasing your pleasurable activities and

maintaining a healthy lifestyle.

Maintenance Antidepressant Medications

Diagnosis:______________________________________________________

You will need to stay on your medications to avoid relapse of depressive symptoms. If you

feel you need to change or stops medications-please call your Primary Care Team. Your

Physician can help you decide the safest options for medication changes.

Other Treatments

Spectrum Health Template - Relapse Prevention Plan