My typical plan of action is to medically screen these patients, including: history, physical exam, labs, urine toxicology screen, and call for a psychiatry consult, if available.
Usually, these patients wait for a long time to be transferred to a psychiatric medical center where they can be evaluated by a psychiatrist.
Now, studies have shown that giving a low-dose ketamine (0.5mg/kg) intravenous push can rapidly alleviate these symptoms.
http://www.ncbi.nlm.nih.gov/m/pubmed/23982301/
http://mobile.nytimes.com/2014/12/10/business/special-k-a-hallucinogen-raises-hopes-and-concerns-as-a-treatment-for-depression.html?referrer=&_r=0
Would it be more beneficial for some patients to be treated with ketamine in the ED with outpatient psychiatry followup?
This would enhance medical care in several ways:
1. No waiting in ED for psych bed
2. Rapid alleviation of depression symptoms
3. Return to home sooner for patients
The next step is to do randomized controlled studies in ED patients who present with suicidal ideation and see if they benefit from a dose of ketamine.
