What is the first and most crucial step in evaluating a patient with symptoms of depression?

The initial and most vital step in evaluating a patient exhibiting symptoms of depression is the assessment of suicidal risk. This is essential because patients with depression can have varying degrees of suicidal ideation or intent, and identifying this risk is paramount in ensuring the patient's safety. It allows healthcare providers to determine the appropriate level of care and intervention that might be necessary, including hospitalization, if there is a significant risk of self-harm.

Recognizing suicidal risk involves directly asking patients about thoughts of self-harm, previous suicide attempts, and any specific plans or means they may have to carry out a suicide. This assessment not only aids in immediate safety but also shapes the overall treatment strategy that will follow.

Other components, such as the physical examination or laboratory tests, are important but come after establishing whether the patient is in immediate danger. Making a treatment plan also cannot occur effectively unless there is a clear understanding of the patient’s risk level. Likewise, while all aspects of a comprehensive evaluation are significant, prioritizing the assessment of suicidal risk forms the foundation of responsible and ethical practice in the treatment of depression.