Clinical Features

Major Depressive Disorder (MDD) - Must have 5 of the following features for >2 wks[1]

  • Depressed mood or anhedonia (must be present)
    • Sleep decreased (Insomnia with 2-4 am awakening)
    • Interest decreased in activities
    • Guilt or worthlessness (Not a major criteria)
    • Energy decreased
    • Concentration difficulties
    • Appetite disturbance or weight loss
    • Psychomotor retardation/agitation
    • Suicidal thoughts

Differential Diagnosis

General Psychiatric


  • Evaluate suicide risk
  • Depression screening with PHQ-9, the PHQ-2, the Beck Depression Inventory for Primary Care, and the WHO-5

General ED Psychiatric Workup


  • Psych consult or admission if high risk of suicide
  • Consider consult with psychiatric team in other cases, particularly if severe symptoms and patient not already plugged into psych care
  • Pharmacologic agents (typically not started in ED due to need for monitoring and adjustment)


See Also

Screening test for depression


  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
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