The emergency physician's responsibility in managing a patient with depression is to maintain a high index of suspicion for the diagnosis, especially in populations at risk for suicide. Although primary at-risk populations include young adults and elderly persons, depression and suicidality can occur in any age group, including children. In any such patient, screening for diagnostic symptoms of major depression and suicidality is mandatory. When a patient has contemplated or attempted suicide, the burden is on the physician to directly explore the situation with the patient in as much detail as possible to determine the current presence of suicidal ideation as well as accessible means and plans. Discussing these is the most important step an ED physician can take in an attempt to prevent suicide in a patient at risk.
Psychotherapeutic interventions act synergistically with pharmacologic therapy.
It is usually reserved for refractory cases, cases of pharmacologic resistance or adverse effects, and where rapid reversal is indicated. The protocol for consultation should be established by the institution and should be the same for every patient. A psychiatrist should be consulted for definitive pharmaceutical intervention. After consultation, it may be appropriate to provide a small amount of the suggested medication to sustain the patient until follow-up. The variety and forms of antidepressant agents available and indications for each are beyond the scope of this article.