Patient Information
Name: _______________________
Date: ________________________
Provider: ____________________
Treatment Goals
- Reduce severity of depressive symptoms
- Improve daily functioning and quality of life
- Develop healthy coping mechanisms
- Prevent relapse
Treatment Components
1. Medication Management
- Prescribed medication(s): ___________________
- Dosage: _________________________________
- Schedule: ________________________________
- Expected side effects: ______________________
- Follow-up appointment date: ________________
2. Psychotherapy
- Type: ☐ CBT ☐ IPT ☐ Other: ______________
- Frequency: _______________________________
- Therapist contact: ________________________
3. Lifestyle Modifications
- Exercise plan: ____________________________
- Sleep hygiene goals: ______________________
- Dietary recommendations: __________________
- Stress management techniques: _____________
4. Support System
- Emergency contact: ________________________
- Support group information: _________________
- Crisis hotline: ____________________________
Monitoring Progress
- PHQ-9 Score: Initial _____ Target _____
- Follow-up schedule: _______________________
- Warning signs to watch for: ________________
Safety Plan
- Identify triggers: ________________________
- Coping strategies: _______________________
- Emergency contacts: _____________________
- Crisis resources: ________________________
Agreement
I understand and agree to participate in this treatment plan:
Patient Signature: _____________ Date: _______
Provider Signature: ____________ Date: _______