Suicidal ideation is an important consideration when prescribing antidepressant medication, especially for:¹⁴

·       people with depression who are aged 18 to 25 years; or

·       other adults who are thought to be at increased risk of suicide.

Mental state and mood should have been assessed before initiating the antidepressant, and ideally in person (or by video or phone call in some circumstances). A risk-management strategy should be in place, and the first review (eg the NMS intervention consultation) should take place one week after starting the medication, again, ideally face to face.

A second follow up review should be no later than four weeks after starting treatment, but more frequent reviews (possibly outside the NMS terms) might be necessary.

As part of risk assessment, NICE says: “Always ask people with depression directly about suicidal ideation and intent.” Questions should explore whether there has been any increased agitation, anxiety or suicidal ideation.

Be aware that external factors may also be playing on the patient’s mind, such as the availability of support, unstable housing, or new life events such as bereavement, break-up of a relationship, or employment changes.

The conversation can then assess whether the person has adequate social support and is aware of sources of help. It may be necessary to arrange help appropriate to the level of need (urgently if necessary), as well as advising the person to seek further help if the situation deteriorates.