Major depressive disorder

Low mood and/or anhedonia with biological, cognitive, functional change for 2+ weeks

EmergentReview due

Compare (8)

At a glance

High-risk causes: 8
Immediate actions: 6
Related differentials: 8

Safety snapshot

Planning, rehearsal, concealed intent, psychotic depression, high-lethality means.

Watch forPlanningrehearsalconcealed intentpsychotic depressionSuicide riskpsychosis

Presentation hinge

Sleep disturbance sits inside a broader syndrome. Reduced need for sleep is one of the most decisive bipolar bedside clues.

Separates the Suicidal Ideation / Suicide Attempt / Self-Harm group. It is not specific to Major depressive disorder.

Points for this presentation

Applies to the Suicidal Ideation / Suicide Attempt / Self-Harm group — not specific to Major depressive disorder

Quiet, organised suicidality is often higher risk than dramatic expression
Mixed states are easy to miss and carry very high suicide risk
Ask about content, controllability, and compliance, not just presence of voices
Do not dismiss recurrent self-harm as low risk

Clinical review

Rows marked “Whole group”: Applies to the Suicidal Ideation / Suicide Attempt / Self-Harm group — not specific to Major depressive disorder

Why it fits

Low mood and/or anhedonia with biological, cognitive, functional change for 2+ weeks

Key features4 features

Hopelessness, anhedonia, guilt, burdensomeness
Sustained wish to die or escape, often with cognitive constriction and pessimism.
Sustained mood syndrome with guilt, hopelessness, reduced energy, impaired concentration, change in sleep/appetite.
Early-morning waking, low energy, anhedonia, tiredness with poor sleep

Must-not-miss

Planning, rehearsal, concealed intent, psychotic depression, high-lethality means.

High-risk causes8 causes

Planning
rehearsal
concealed intent
psychotic depression
high-lethality means
Suicide risk
psychosis
catatonia

Bedside question

Applies to the Suicidal Ideation / Suicide Attempt / Self-Harm group.

Sleep disturbance sits inside a broader syndrome. Reduced need for sleep is one of the most decisive bipolar bedside clues.

Helpful clues2 clues

Sustained wish to die or escape, often with cognitive constriction and pessimism.
Sustained mood syndrome with guilt, hopelessness, reduced energy, impaired concentration, change in sleep/appetite.

Immediate action

Applies to the Suicidal Ideation / Suicide Attempt / Self-Harm group.

Quiet, organised suicidality is often higher risk than dramatic expression Mixed states are easy to miss and carry very high suicide risk Ask about content, controllability, and compliance, not just presence of voices Do not dismiss recurrent self-harm as low risk Focus on intent, lethality, acute change, dissociation, substance use Dissociated acts can be impulsive yet highly dangerous

Priority steps6 steps

1Quiet, organised suicidality is often higher risk than dramatic expression
2Mixed states are easy to miss and carry very high suicide risk
3Ask about content, controllability, and compliance, not just presence of voices
4Do not dismiss recurrent self-harm as low risk
5Focus on intent, lethality, acute change, dissociation, substance use
6Dissociated acts can be impulsive yet highly dangerous

Investigations

Applies to the Suicidal Ideation / Suicide Attempt / Self-Harm group.

None listed

Core tests

Mimics / overlap

Applies to the Suicidal Ideation / Suicide Attempt / Self-Harm group.

None listed

Consider

Clinical reference — not validated decision support. Review before use.