History A 33-year-old phlebotomist presents to the emergency department with his girlfriend to get a repeat prescription of his antidepressant citalopram. He seems very restless, pacing up and down the waiting room. He is mumbling to himself and intermittently starts singing rather loudly. He is wearing bright clothes and lots of jewellery. The girlfriend states that he used up 4 weeks’ worth of medication in 2 weeks.
When the staff nurse approaches him to calm him, he starts shouting and swearing loudly and becomes quite intimidating and threatening. He was first diagnosed with depression 5 years ago and responded well to citalopram 20 mg once a day, which was discontinued after a year. Six months ago he became depressed once again and was again prescribed citalopram 20 mg a day. He has been seen every four weeks at the GP surgery since then and has been quite well. On his last visit 2…
