From the Guidelines
If you're experiencing a mental health emergency related to depression, seek immediate help by calling 911 or going to your nearest emergency room, especially if you're having suicidal thoughts or plans. The National Suicide Prevention Lifeline (988) provides 24/7 support. Emergency care for severe depression typically involves a psychiatric evaluation to assess suicide risk and determine appropriate treatment. In the emergency setting, providers may administer medications like benzodiazepines (such as lorazepam 0.5-2mg) for acute anxiety or agitation, or initiate antidepressants if needed, as supported by studies on the comparative benefits and harms of antidepressant treatments for major depression 1. Hospital admission may be recommended for those at high risk of self-harm. After emergency stabilization, follow-up care is crucial, including regular appointments with mental health professionals and possibly medication adjustments. Some key considerations in emergency care for depression include:
- Assessing the severity of symptoms and the risk of self-harm
- Providing a safe and supportive environment
- Initiating treatment with medications or other therapies as needed
- Ensuring follow-up care and support to prevent future emergencies Emergency intervention is warranted when depression symptoms become severe enough to threaten safety or basic functioning, as prompt treatment can prevent harmful outcomes and begin the recovery process, highlighting the importance of timely and effective care in emergency situations 1.
From the Research
Emergency Care for Depression
- Depression is a significant component of bipolar disorder, and its treatment is crucial in emergency care settings 2, 3, 4, 5, 6.
- The treatment of bipolar depression is challenging, and differentiating it from major depressive disorder is essential to avoid incorrect treatment and poor outcomes 2.
- Several medications are approved for the treatment of bipolar depression, including olanzapine/fluoxetine combination, quetiapine, and lurasidone, each with its efficacy profile and tolerability 2.
Medication Options
- Quetiapine is a commonly prescribed medication for bipolar depression, and its efficacy has been studied in various trials 3, 4, 5, 6.
- Lithium is another widely used medication for bipolar disorder, and its effectiveness as monotherapy has been demonstrated in several studies 4, 5, 6.
- Combination therapy, including quetiapine and lithium, may be more effective than monotherapy in certain cases, but the choice of treatment depends on individual patient needs and circumstances 3, 4.
Treatment Outcomes
- Studies have shown that lithium may be more successful as monotherapy maintenance treatment than valproate, olanzapine, or quetiapine 5, 6.
- Treatment failure rates vary among different medications, with olanzapine having the highest hazard ratio for treatment failure compared to lithium 6.
- The choice of medication should be based on individual patient characteristics, medical history, and treatment goals, as well as consideration of potential adverse events and tolerability 2, 3, 4, 5, 6.