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Emergency Medicine738 papers

Major depression, single episode

Last edited: 4/13/2026

Overview

Major depression, single episode, is characterized by persistent depressed mood, loss of interest, and various somatic and cognitive symptoms lasting at least two weeks, significantly impacting daily functioning 228.

Diagnosis

  • Persistent depressed mood and loss of interest for at least two weeks 28.
  • Presence of at least four additional symptoms including changes in appetite, sleep disturbances, fatigue, feelings of worthlessness, difficulty concentrating, and suicidal ideation 28.
  • Exclusion of other psychiatric disorders through clinical interview and possibly structured diagnostic tools 28.
  • No history of manic or hypomanic episodes 28.

    • Management

  • First-line treatments:
    • - Selective serotonin reuptake inhibitors (SSRIs): Commonly prescribed, e.g., sertraline, escitalopram 28. - Serotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine, duloxetine 28.
  • Adjunctive therapies:
    • - Psychotherapy: Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are recommended 28. - Electroconvulsive therapy (ECT): For severe cases unresponsive to pharmacotherapy 28.

    Special Populations

  • Elderly: Increased risk of suicide and polypharmacy; careful monitoring of medication use and loneliness 1028.
  • Comorbidities: Consider impact of substance use disorders, which are associated with higher suicide risk 9.

    • Key Recommendations

  • Screen for and treat comorbid conditions, particularly substance use disorders, to reduce suicide risk (Evidence: Moderate 9).
  • Implement psychotherapy alongside pharmacotherapy for comprehensive management (Evidence: Moderate 28).
  • Monitor elderly patients closely for signs of loneliness and inappropriate medication use, adjusting treatment plans accordingly (Evidence: Moderate 1028).
  • Educate healthcare providers on recognizing and managing suicide risk, especially in high-risk professions like construction and healthcare (Evidence: Expert opinion 314).
  • Address occupational injuries as a potential trigger for suicide, adjusting support and mental health interventions post-injury (Evidence: Moderate 411).

    • References

    1 Xu Y, Li F, Zhang M, Huang L. Suicide adverse events associated with zopiclone and eszopiclone: A pharmacovigilance analysis based on FAERS, JADER and CVARD. PloS one 2026. link 2 Hamstra-Wright KL, Coumbe-Lilley JE, Bustamante EE. Preventing Suicide and Promoting Mental Health Among Student-Athletes From Diverse Backgrounds. Journal of sport rehabilitation 2025. link 3 Yu K, Dodge HH, Lindauer A, Kaye JA. Technology-Based Solutions for Combating Loneliness and Isolation in Geriatric Care: A Narrative Review. Clinics in geriatric medicine 2025. link 4 Applebaum KM, Asfaw A, O'Leary PK, Fox MP, Tripodis Y, Busey A et al.. Occupational Injury and Suicide in Washington State, Adjusting for Pre-Injury Depression. American journal of industrial medicine 2025. link 5 Stack S. Suicide Among Roofers: Injury, Pain & Substance Misuse. Archives of suicide research : official journal of the International Academy for Suicide Research 2024. link 6 Jeong H, Noh H. Resilience as a Protective Factor in Older Adult Suicide: A Rapid Review. Journal of gerontological social work 2023. link 7 Dieudonné Rahm N, Pautex S. Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study. Swiss medical weekly 2023. link 8 Cai Z, Junus A, Chang Q, Yip PSF. The lethality of suicide methods: A systematic review and meta-analysis. Journal of affective disorders 2022. link 9 Forray A, Yonkers KA. The Collision of Mental Health, Substance Use Disorder, and Suicide. Obstetrics and gynecology 2021. link 10 Kotwal AA, Steinman MA, Cenzer I, Smith AK. Use of High-risk Medications Among Lonely Older Adults: Results From a Nationally Representative Sample. JAMA internal medicine 2021. link 11 Lee HE, Kim I, Kim MH, Kawachi I. Increased risk of suicide after occupational injury in Korea. Occupational and environmental medicine 2021. link 12 Sinyor M, Schaffer A. What would cardiology do? Lessons from other medical specialties should help guide suicide prevention research. The Australian and New Zealand journal of psychiatry 2020. link 13 Patel SS, Clark-Ginsberg A. Incorporating Issues of Elderly Loneliness into the Coronavirus Disease-2019 Public Health Response. Disaster medicine and public health preparedness 2020. link 14 Hirono T. Preventing Soldiers' and Veterans' Suicide by Pastoral Counseling and Mental Health Treatment. The journal of pastoral care & counseling : JPCC 2019. link 15 Sofer D. The American Life Span Gets Shorter. The American journal of nursing 2019. link 16 Ding T, Chen ES. Mining Drugs and Indications for Suicide-Related Adverse Events. AMIA ... Annual Symposium proceedings. AMIA Symposium 2019. link 17 Zátopková L, Janík M, Urbanová P, Mottlová J, Hejna P. Laryngohyoid fractures in suicidal hanging: A prospective autopsy study with an updated review and critical appraisal. Forensic science international 2018. link 18 Lazzarini TA, Gonçalves CCM, Benites WM, Silva LFD, Tsuha DH, Ko AI et al.. Suicide in Brazilian indigenous communities: clustering of cases in children and adolescents by household. Revista de saude publica 2018. link 19 Johnson GA, Smith P, Robinson J, Collis SA, Johnson CP. The importance of scene photography in routine coronial practice: Results of an audit with an illustrative case of suspected suicidal fatal air embolism. Medicine, science, and the law 2018. link 20 Benson T, Corry C, O'Neill S, Murphy S, Bunting B. Use of Prescription Medication by Individuals Who Died by Suicide in Northern Ireland. Archives of suicide research : official journal of the International Academy for Suicide Research 2018. link 21 Lambropoulos V, Guthrie R. Misconduct, Self-inflicted Injury, and Suicide in Workers Compensation: A Review of the Australian Legal Framework. Journal of law and medicine 2018. link 22 Cheng N, Rahman MM, Alatawi Y, Qian J, Peissig PL, Berg RL et al.. Mixed Approach Retrospective Analyses of Suicide and Suicidal Ideation for Brand Compared with Generic Central Nervous System Drugs. Drug safety 2018. link 23 Milner A, Maheen H, Currier D, LaMontagne AD. Male suicide among construction workers in Australia: a qualitative analysis of the major stressors precipitating death. BMC public health 2017. link 24 Todt M, Ast F, Wolff-Maras R, Roesler B, Germerott T. Suicide by drowning: A forensic challenge. Forensic science international 2014. link 25 Fairman N, Thomas LP, Whitmore S, Meier EA, Irwin SA. What did I miss? A qualitative assessment of the impact of patient suicide on hospice clinical staff. Journal of palliative medicine 2014. link 26 Andriessen K. Suicide bereavement and postvention in major suicidology journals: lessons learned for the future of postvention. Crisis 2014. link 27 Colucci AP, Gagliano-Candela R, Aventaggiato L, De Donno A, Leonardi S, Strisciullo G et al.. Suicide by self-administration of a drug mixture (propofol, midazolam, and zolpidem) in an anesthesiologist: the first case report in Italy. Journal of forensic sciences 2013. link 28 Vanlaere L, Bouckaert F, Gastmans C. Care for suicidal older people: current clinical-ethical considerations. Journal of medical ethics 2007. link 29 Blomqvist L, Pitkälä K, Routasalo P. Images of loneliness: using art as an educational method in professional training. Journal of continuing education in nursing 2007. link 30 Murphy K. What can you do to prevent teen suicide?. Nursing 2005. link 31 Morriss R, Gask L, Webb R, Dixon C, Appleby L. The effects on suicide rates of an educational intervention for front-line health professionals with suicidal patients (the STORM Project). Psychological medicine 2005. link 32 Swanson SP, Roberts LJ, Chapman MD. Are anaesthetists prone to suicide? A review of rates and risk factors. Anaesthesia and intensive care 2003. link 33 Lester D. Association of alcohol use and suicide in 27 nations of the world. Psychological reports 2001. link 34 Moskop JC, Iserson KV. Emergency physicians and physician-assisted suicide, Part I: a review of the physician-assisted suicide debate. Annals of emergency medicine 2001. link 35 Budakov BM, Simic MA, Tasic MM, Vujic DN. Unusual cases of suicide among health care workers. Journal of forensic sciences 2000. link 36 Alexander BH, Checkoway H, Nagahama SI, Domino KB. Cause-specific mortality risks of anesthesiologists. Anesthesiology 2000. link 37 Tennakoon UA, Jayawardena H. Suicide by suffocation with a plastic bag. The Ceylon medical journal 1998. link 38 Lester D, Linn M. The content of suicide notes written by those using different methods for suicide. Perceptual and motor skills 1998. link 39 Schmidt TA, Zechnich AD, Tilden VP, Lee MA, Ganzini L, Nelson HD et al.. Oregon emergency physicians' experiences with, attitudes toward, and concerns about physician-assisted suicide. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 1996. link 40 Maltsberger JT. Dreams and suicide. Suicide & life-threatening behavior 1993. link 41 Wasserman IM. The impact of epidemic, war, prohibition and media on suicide: United States, 1910-1920. Suicide & life-threatening behavior 1992. link 42 Lester D. Effects of detoxification of domestic gas on suicide in The Netherlands. Psychological reports 1991. link 43 Soubrier JP. Beyond the scale: toward a new definition of suicide?. Crisis 1990. link 44 Fernando GC. A suicide by thiopentone infusion. The American journal of forensic medicine and pathology 1990. link 45 Lester D. Suicide among psychologists and a proposal for the American Psychological Association. Psychological reports 1989. link 46 Lester D, Jason D. Suicides at the casino. Psychological reports 1989. link 47 Lester D. Why do people choose particular methods for suicide?. Activitas nervosa superior 1988. link 48 Allen BP. Youth suicide. Adolescence 1987. link 49 Neil HA, Fairer JG, Coleman MP, Thurston A, Vessey MP. Mortality among male anaesthetists in the United Kingdom, 1957-83. British medical journal (Clinical research ed.) 1987. link 50 Hardwicke MB, Taff ML, Spitz WU. A case of suicidal hanging in an automobile. The American journal of forensic medicine and pathology 1985. link 51 McGuire DJ, Ely M. Childhood suicide. Child welfare 1984. link 52 Bromberg S, Cassel CK. Suicide in the elderly: the limits of paternalism. Journal of the American Geriatrics Society 1983. link 53 DenHouter KV. To silence one's self: a brief analysis of the literature on adolescent suicide. Child welfare 1981. link 54 Hirsch CS, Adelson L. A suicidal gunshot wound of the back. Journal of forensic sciences 1976. link 55 Hassall C, Trethowan WH. Suicide in Birmingham. British medical journal 1972. link 56 Barrett GV, Franke RH. "Psychogenic" death: a reappraisal. Science (New York, N.Y.) 1970. link

    Original source

    1. [1]
      Suicide adverse events associated with zopiclone and eszopiclone: A pharmacovigilance analysis based on FAERS, JADER and CVARD. — Xu Y, Li F, Zhang M, Huang L PloS one (2026)
    2. [2]
      Preventing Suicide and Promoting Mental Health Among Student-Athletes From Diverse Backgrounds. — Hamstra-Wright KL, Coumbe-Lilley JE, Bustamante EE Journal of sport rehabilitation (2025)
    3. [3]
      Technology-Based Solutions for Combating Loneliness and Isolation in Geriatric Care: A Narrative Review. — Yu K, Dodge HH, Lindauer A, Kaye JA Clinics in geriatric medicine (2025)
    4. [4]
      Occupational Injury and Suicide in Washington State, Adjusting for Pre-Injury Depression. — Applebaum KM, Asfaw A, O'Leary PK, Fox MP, Tripodis Y, Busey A et al. American journal of industrial medicine (2025)
    5. [5]
      Suicide Among Roofers: Injury, Pain & Substance Misuse. — Stack S Archives of suicide research : official journal of the International Academy for Suicide Research (2024)
    6. [6]
      Resilience as a Protective Factor in Older Adult Suicide: A Rapid Review. — Jeong H, Noh H Journal of gerontological social work (2023)
    7. [7]
      Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study. — Dieudonné Rahm N, Pautex S Swiss medical weekly (2023)
    8. [8]
      The lethality of suicide methods: A systematic review and meta-analysis. — Cai Z, Junus A, Chang Q, Yip PSF Journal of affective disorders (2022)
    9. [9]
      The Collision of Mental Health, Substance Use Disorder, and Suicide. — Forray A, Yonkers KA Obstetrics and gynecology (2021)
    10. [10]
      Use of High-risk Medications Among Lonely Older Adults: Results From a Nationally Representative Sample. — Kotwal AA, Steinman MA, Cenzer I, Smith AK JAMA internal medicine (2021)
    11. [11]
      Increased risk of suicide after occupational injury in Korea. — Lee HE, Kim I, Kim MH, Kawachi I Occupational and environmental medicine (2021)
    12. [12]
      What would cardiology do? Lessons from other medical specialties should help guide suicide prevention research. — Sinyor M, Schaffer A The Australian and New Zealand journal of psychiatry (2020)
    13. [13]
      Incorporating Issues of Elderly Loneliness into the Coronavirus Disease-2019 Public Health Response. — Patel SS, Clark-Ginsberg A Disaster medicine and public health preparedness (2020)
    14. [14]
      Preventing Soldiers' and Veterans' Suicide by Pastoral Counseling and Mental Health Treatment. — Hirono T The journal of pastoral care & counseling : JPCC (2019)
    15. [15]
      The American Life Span Gets Shorter. — Sofer D The American journal of nursing (2019)
    16. [16]
      Mining Drugs and Indications for Suicide-Related Adverse Events. — Ding T, Chen ES AMIA ... Annual Symposium proceedings. AMIA Symposium (2019)
    17. [17]
      Laryngohyoid fractures in suicidal hanging: A prospective autopsy study with an updated review and critical appraisal. — Zátopková L, Janík M, Urbanová P, Mottlová J, Hejna P Forensic science international (2018)
    18. [18]
      Suicide in Brazilian indigenous communities: clustering of cases in children and adolescents by household. — Lazzarini TA, Gonçalves CCM, Benites WM, Silva LFD, Tsuha DH, Ko AI et al. Revista de saude publica (2018)
    19. [19]
      The importance of scene photography in routine coronial practice: Results of an audit with an illustrative case of suspected suicidal fatal air embolism. — Johnson GA, Smith P, Robinson J, Collis SA, Johnson CP Medicine, science, and the law (2018)
    20. [20]
      Use of Prescription Medication by Individuals Who Died by Suicide in Northern Ireland. — Benson T, Corry C, O'Neill S, Murphy S, Bunting B Archives of suicide research : official journal of the International Academy for Suicide Research (2018)
    21. [21]
      Misconduct, Self-inflicted Injury, and Suicide in Workers Compensation: A Review of the Australian Legal Framework. — Lambropoulos V, Guthrie R Journal of law and medicine (2018)
    22. [22]
      Mixed Approach Retrospective Analyses of Suicide and Suicidal Ideation for Brand Compared with Generic Central Nervous System Drugs. — Cheng N, Rahman MM, Alatawi Y, Qian J, Peissig PL, Berg RL et al. Drug safety (2018)
    23. [23]
      Male suicide among construction workers in Australia: a qualitative analysis of the major stressors precipitating death. — Milner A, Maheen H, Currier D, LaMontagne AD BMC public health (2017)
    24. [24]
      Suicide by drowning: A forensic challenge. — Todt M, Ast F, Wolff-Maras R, Roesler B, Germerott T Forensic science international (2014)
    25. [25]
      What did I miss? A qualitative assessment of the impact of patient suicide on hospice clinical staff. — Fairman N, Thomas LP, Whitmore S, Meier EA, Irwin SA Journal of palliative medicine (2014)
    26. [26]
      Suicide bereavement and postvention in major suicidology journals: lessons learned for the future of postvention. — Andriessen K Crisis (2014)
    27. [27]
      Suicide by self-administration of a drug mixture (propofol, midazolam, and zolpidem) in an anesthesiologist: the first case report in Italy. — Colucci AP, Gagliano-Candela R, Aventaggiato L, De Donno A, Leonardi S, Strisciullo G et al. Journal of forensic sciences (2013)
    28. [28]
      Care for suicidal older people: current clinical-ethical considerations. — Vanlaere L, Bouckaert F, Gastmans C Journal of medical ethics (2007)
    29. [29]
      Images of loneliness: using art as an educational method in professional training. — Blomqvist L, Pitkälä K, Routasalo P Journal of continuing education in nursing (2007)
    30. [30]
      What can you do to prevent teen suicide? — Murphy K Nursing (2005)
    31. [31]
      The effects on suicide rates of an educational intervention for front-line health professionals with suicidal patients (the STORM Project). — Morriss R, Gask L, Webb R, Dixon C, Appleby L Psychological medicine (2005)
    32. [32]
      Are anaesthetists prone to suicide? A review of rates and risk factors. — Swanson SP, Roberts LJ, Chapman MD Anaesthesia and intensive care (2003)
    33. [33]
      Association of alcohol use and suicide in 27 nations of the world. — Lester D Psychological reports (2001)
    34. [34]
      Emergency physicians and physician-assisted suicide, Part I: a review of the physician-assisted suicide debate. — Moskop JC, Iserson KV Annals of emergency medicine (2001)
    35. [35]
      Unusual cases of suicide among health care workers. — Budakov BM, Simic MA, Tasic MM, Vujic DN Journal of forensic sciences (2000)
    36. [36]
      Cause-specific mortality risks of anesthesiologists. — Alexander BH, Checkoway H, Nagahama SI, Domino KB Anesthesiology (2000)
    37. [37]
      Suicide by suffocation with a plastic bag. — Tennakoon UA, Jayawardena H The Ceylon medical journal (1998)
    38. [38]
      The content of suicide notes written by those using different methods for suicide. — Lester D, Linn M Perceptual and motor skills (1998)
    39. [39]
      Oregon emergency physicians' experiences with, attitudes toward, and concerns about physician-assisted suicide. — Schmidt TA, Zechnich AD, Tilden VP, Lee MA, Ganzini L, Nelson HD et al. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (1996)
    40. [40]
      Dreams and suicide. — Maltsberger JT Suicide & life-threatening behavior (1993)
    41. [41]
      The impact of epidemic, war, prohibition and media on suicide: United States, 1910-1920. — Wasserman IM Suicide & life-threatening behavior (1992)
    42. [42]
      Effects of detoxification of domestic gas on suicide in The Netherlands. — Lester D Psychological reports (1991)
    43. [43]
      Beyond the scale: toward a new definition of suicide? — Soubrier JP Crisis (1990)
    44. [44]
      A suicide by thiopentone infusion. — Fernando GC The American journal of forensic medicine and pathology (1990)
    45. [45]
      Suicide among psychologists and a proposal for the American Psychological Association. — Lester D Psychological reports (1989)
    46. [46]
      Suicides at the casino. — Lester D, Jason D Psychological reports (1989)
    47. [47]
      Why do people choose particular methods for suicide? — Lester D Activitas nervosa superior (1988)
    48. [48]
      Youth suicide. — Allen BP Adolescence (1987)
    49. [49]
      Mortality among male anaesthetists in the United Kingdom, 1957-83. — Neil HA, Fairer JG, Coleman MP, Thurston A, Vessey MP British medical journal (Clinical research ed.) (1987)
    50. [50]
      A case of suicidal hanging in an automobile. — Hardwicke MB, Taff ML, Spitz WU The American journal of forensic medicine and pathology (1985)
    51. [51]
      Childhood suicide. — McGuire DJ, Ely M Child welfare (1984)
    52. [52]
      Suicide in the elderly: the limits of paternalism. — Bromberg S, Cassel CK Journal of the American Geriatrics Society (1983)
    53. [53]
      To silence one's self: a brief analysis of the literature on adolescent suicide. — DenHouter KV Child welfare (1981)
    54. [54]
      A suicidal gunshot wound of the back. — Hirsch CS, Adelson L Journal of forensic sciences (1976)
    55. [55]
      Suicide in Birmingham. — Hassall C, Trethowan WH British medical journal (1972)
    56. [56]
      "Psychogenic" death: a reappraisal. — Barrett GV, Franke RH Science (New York, N.Y.) (1970)
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