Red flags

During the initial phase of anti-depressant treatment, there is an increased risk that the patient may experience suicidal ideation and other mood changes. This is because antidepressants can increase both energy and motivation levels, which begin to rise prior to the depression starting to lift. There is then an increased risk that the person may have more energy and motivation to act on suicidal intent before their mood starts to improve.

This risk is particularly high in young people under the age of 25, but it can occur in any individual newly starting an antidepressant medication. If a patient reports a deterioration in their mood on starting an antidepressant, it is important that they are urgently referred back to their GP for further review.

If any patient expresses suicidal ideation or discloses thoughts or plans to harm themselves, it is essential that these risks are highlighted to the patient’s GP immediately. If a patient is in crisis and has active plans to harm themselves or end their life, they should be referred to the local urgent care service.

Urgent mental health support can also be sought by calling 111 and selecting option 2. If you are concerned that
a patient’s life is in imminent danger, support can be sought via 999 or A&E.