From the Guidelines
Individuals with depression who seek care in emergency settings typically present with more severe symptoms where biological and psychiatric factors likely play a dominant role over health behaviors. When treating these emergency presentations, clinicians should prioritize immediate safety assessment and stabilization, often using medications like SSRIs (such as sertraline 50-200mg daily or escitalopram 10-20mg daily) for ongoing treatment, potentially with short-term benzodiazepines for acute anxiety or agitation, as recommended by the American College of Physicians 1. For severe cases, consider psychiatric hospitalization, especially with suicidal ideation. While health behaviors like exercise, sleep hygiene, and nutrition remain important for long-term management, they are secondary concerns during acute crises. This approach recognizes that emergency presentations often involve more complex biological dysregulation, comorbidities, and acute stressors that require immediate medical intervention before lifestyle modifications can be effectively implemented.
Key Considerations
- The most recent guidelines from the American Society of Clinical Oncology 1 emphasize the importance of screening for depressive symptoms in adults with cancer, using tools like the PHQ-9, and assessing for risk of harm to self or others.
- The American College of Physicians recommends selecting between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient 1.
- For adolescents with depression, guidelines recommend a multifaceted approach including practice preparation, identification, assessment, and initial management, with a focus on integrated care models and collaboration with mental health professionals 1.
Treatment Approach
- Medication management with SSRIs is a first-line treatment for moderate to severe depression, with potential augmentation with other medications or therapies as needed, based on guidelines from the American College of Physicians 1.
- Psychiatric hospitalization should be considered for severe cases, especially with suicidal ideation, as recommended by the American Academy of Pediatrics 1.
- Health behaviors like exercise, sleep hygiene, and nutrition are important for long-term management but are secondary concerns during acute crises, as emphasized by the American College of Physicians 1.
From the Research
Clinical Heterogeneity of Depression
- The clinical heterogeneity of depression can lead to individuals seeking care in emergency settings presenting with more severe and complex symptomatology 2.
- In such cases, the influence of health behaviors may be less prominent compared to underlying biological or psychiatric factors.
Influence of Health Behaviors
- There is limited research on the direct influence of health behaviors on depression in emergency settings.
- However, studies suggest that crisis intervention and treatment of depression can improve outcomes, regardless of health behaviors 3, 4, 5.
Treatment of Depression
- Crisis intervention has been shown to be effective in reducing admission rates and improving outpatient follow-ups for patients with major depressive disorder 3.
- Selective serotonin reuptake inhibitors, such as sertraline and fluoxetine, have been found to be effective in treating depression, with similar efficacy and tolerability profiles 4, 5.
Emergency Department Utilization
- Depression has been found to be associated with increased emergency department utilization, including increased rates of ED visits and hospitalizations 2.
- Recognizing and managing psychiatric emergencies, including panic attacks and adverse drug reactions, is crucial for emergency department healthcare providers 6.