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Depression Causing Weight Loss — RACP Adult Medicine MCQ

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ModerateNeurologyDepression Causing Weight LossRACP Adult Medicine

A 75-year-old widowed man presents with 7 kg weight loss over 4 months. He reports poor appetite, early morning waking, anhedonia, and social withdrawal since his wife died 8 months ago. Examination is unremarkable. Basic bloods (FBE, UEC, LFTs, TFTs, CRP, glucose, calcium) are normal. CT chest/abdomen/pelvis is normal. Colonoscopy is normal. What is the most likely underlying cause?

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Correct answer: B — Depression

Unintentional weight loss with anhedonia, poor appetite, early morning waking, social withdrawal after bereavement, and negative investigation workup (bloods, CT, colonoscopy) is major depressive disorder. Depression is an important and underdiagnosed cause of weight loss in the elderly. A formal psychiatric assessment using PHQ-9 or GDS is indicated. Treatment: antidepressant therapy (mirtazapine may be beneficial due to appetite-stimulating properties) and psychotherapy.

Reference: eTG Psychotropic – 2024 – Depression; RANZCP 2024