• Depression is a major public health problem as a leading predictor of functional disability and mortality. • Optimal depression treatment improves outcome for most patients. • Most adults with clinical significant depression never see a mental health professional but they often visit a primary care physician. • A physician, who is not a psychiatrist, misses the diagnosis of the depression 50% of times. • All depressed patients must be enquired specifically about suicidal ideations. • Suicidal ideation is a medical emergency. • Risk factors for suicide are known psychiatric disorders, medical illness, prior history of suicidal attempts, or family history of attempted suicide. • Demographic reasons include older age, male gender, marital status (widowed or separated) and living alone. • World over about 1 million people commit suicide every year. • Seventy–nine percent of patients who commit suicide contact their primary care provider in the last one year before their death and only one–third contact their mental health service provider. • Twice as many suicidal victims had contacted with their primary care provider as against the mental health provider in the last month before suicide. • Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths. • In the US,the suicidal rate is 10.5 per 100,000 people. • In the US,incidence of suicide is increasing in middle aged adults. • There are 10–40 non–fatal suicide attempts for every one completed suicide. • The majority of suicides completed in US are accomplished with firearm (57%); the second leading method of suicide in US is hanging for men and poisoning in women. • Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt. • Fifty percent of successful victims have made prior attempts. • One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt. • The risk of suicide increases with increase in age; however, younger and adolescents attempt suicide more than the older. • Females attempt suicide more frequently than males but males are successful three times more often. • The highest suicidal rate is amongst those individuals who are unmarried followed by widowed, separated, divorced, married without children and married with children in descending order. • Living alone increases the risk of suicide. • Unemployed and unskilled patients are at higher risk of suicide than those who are employed. • A recent sense of failure may lead to higher risk. • Clinicians are at higher risk of suicide. • The suicidal rate in male clinicians is 1.41 and in female clinicians it is 2.27. • Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts. • The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration. • Management of a suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up. • Major risk for suicidal attempts is in psychiatric disorders, hopelessness and prior suicidal attempts or threats. • High impulsivity or alcohol or other substance abuse increase the risk.