How are depression and suicide treated in the emergency department?

Updated: Sep 02, 2020
  • Author: Louise B Andrew, MD, JD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Antidepressant therapy generally would not be initiated in the emergency department, although regional variations in this standard exist. A psychiatrist or mental health professional with prescribing privileges 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. It may also be appropriate to renew a previously effective medication in small quantities and with the assurance of a follow-up mechanism that is accessible and acceptable to the patient.

A fast-acting intervention in acute depression with suicidality that is currently being reviewed in the emergency medicine literature is the use of a low-dose intravenous bolus of ketamine. [31]

Psychotherapeutic interventions act synergistically with pharmacologic therapy. Guidelines for the treatment of patients with major depressive disorder have been updated by the American Psychiatric Association and are available on their Web site. [4]


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