A 29-year-old man with a history of depression and possible psychosis was found unconscious and unresponsive at home and was brought to the emergency department. He was tachycardic, hypertensive, and unresponsive to painful stimuli. His electrocardiogram revealed tachycardia, QT prolongation, QRS widening, and a nonspecific intraventricular conduction delay, all evidence of potentially dangerous heart rhythms. He was intubated for airway protection and given activated charcoal through a nasogastric tube to treat a presumed drug overdose. He was also treated with a bicarbonate drip, which can help suppress overdose-related arrhythmias. Further history obtained from the paramedics revealed that the patient had been prescribed amitriptyline, a tricyclic antidepressant, and risperidone, an antipsychotic medication, by his primary care physician to treat his psychiatric conditions. Empty bottles of both were found on the floor near the patient at his home, and it was presumed that he had overdosed on the medications as a suicide attempt. The patient survived the episode without any life-threatening arrhythmias and was transferred to an inpatient psychiatric ward once he was stabilized. A good team would allow practitioners to seek consultation or other resources when dealing with complex topics. Suicide prevention includes eliminating harmful objects in the patient's environment, including excess medications. Psychiatric medications need to be managed with attention to safety principles, such as interactions, prevention of polypharmacy, good prescribing practice. Care misses need to be assessed.

depression

psychosis

emergency department

overdose

suicide prevention