Division of Geriatrics, Department of Internal Medicine, Marmara University Medical School, Istanbul, Turkey.
J Nerv Ment Dis. 2022 Aug 1;210(8):640-642. doi: 10.1097/NMD.0000000000001517.
Unintentional weight loss is defined as a more than 5% decrease in body weight within 1 year. Various physical and psychiatric etiologies cause unintentional weight loss, including major depressive disorder (MDD). We present the case of a 69-year-old woman who lost 10 kg in 2 months. She had anhedonia, mobility limitations, and incontinence. Her Mini Nutritional Assessment score indicated malnutrition, whereas her Geriatric Depression Scale score indicated a diagnosis of MDD. Whole-body fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography showed intensely increased FDG uptake in the muscles adjacent to the right and left mandibular rami and the temporal muscle, compatible with jaw clenching associated with the patient's MDD. Subsequent temporal muscle biopsy did not suggest the causes of malignant disorders, dermatomyositis, or polymyositis. Having ruled out all possible organic pathologies, the patient was thus diagnosed with MDD. Escitalopram was prescribed for her MDD, and oral nutritional supplement treatments were initiated for her malnutrition. Patients who present with unintentional weight loss should be assessed first for physical etiologies, and then psychiatric etiologies, particularly as weight loss may be a major symptom of MDD in older adults.
非有意体重减轻的定义为 1 年内体重下降超过 5%。多种躯体和精神病因可导致非有意体重减轻，包括重性抑郁障碍（MDD）。我们介绍了 1 例 69 岁女性，2 个月内体重减轻了 10kg。她有快感缺失、活动受限和尿失禁。其微型营养评定量表提示存在营养不良，而其老年抑郁量表评分提示 MDD 诊断。全身氟脱氧葡萄糖（FDG）-正电子发射断层扫描/计算机断层扫描显示右侧和左侧下颌支及颞肌旁肌肉 FDG 摄取明显增加，与患者的 MDD 相关的咬牙有关。随后的颞肌活检未提示恶性疾病、皮肌炎或多发性肌炎的病因。排除所有可能的器质性病变后，患者被诊断为 MDD。为她开具了艾司西酞普兰治疗 MDD，并开始口服营养补充剂治疗她的营养不良。出现非有意体重减轻的患者应首先评估躯体病因，然后评估精神病因，特别是体重减轻可能是老年 MDD 的一个主要症状。
