Concluded Case

this a young male Pt with h,/0 of anxiety depression 2yrs .now stable but have weight gain puffiness on face bl pitting edema also develope rough facial skin and ring worm like infection. no Ho of hypothyroid.

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Known fact antidepressants like olenzepine increases weight and salt retention. Even tricyclic antidepressants do also cause same side effects so also in some pts it is known to increase sucidal tendency . And this puffiness and dryness is the cause of fungal infections so treatment has to include counseling diet and salt restrictions exercises with diuretics and antifungal treatment without steroids. Also check 24hrs urine for albuminurea and kfts pt may need protein suppliments as proteinurea resulting hypoproteinemia and hence oedema so proper evaluation will help

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Known fact antidepressants like olenzepine increases weight and salt retention. Even tricyclic antidepressants do also cause same side effects so also in some pts it is known to increase sucidal tendency . And this puffiness and dryness is the cause of fungal infections so treatment has to include counseling diet and salt restrictions exercises with diuretics and antifungal treatment without steroids. Also check 24hrs urine for albuminurea and kfts pt may need protein suppliments as proteinurea resulting hypoproteinemia and hence oedema so proper evaluation will help

Thanx dr Shital Jadhav
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Explore other causes of weight gain like cardiac, hepatic & renal causes by first going for proper clinical history taking & then by investigating through Echocardiography, LFT, KFT & USG whole abdomen. Take the history of substance abuse like ALCOHOL to ameliorate his anxiety & depression. Also take the drug history, if any to treat his psychiatric symptoms. If he has been taking psychopharmacologic agents, then refer him to a psychiatrist, for his reevaluation & proper treatment.

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Worthwhile to check for anti thyroglobulin and anti thyroid peroxidace antibodies. Renal profile. Salivary cortisol test..CRP..other hormone assays would throw light. Since obesity is there ..do check the cardiac parameters too. Did the depression precede the other symptoms? Then you need a good psychiatric evaluation..is he suicidal? Then Medication, monitoring ASAP. Provided cardiac and renal parametres with LFT is ok. If the depression came along with, or after other symptoms, and if the patient's symptoms are not severe or with suicidal thoughts..then we can try waiting for the hormonal assay. But the decision to start an antidepressant is important and when to start is important. Another important issue to be evaluated is for psychotic symptoms

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Moon face May be steriod induced Check cbc KFT, LFT, thyroid profile Check hormones also

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Please gp for TSH S.Cortisol RBS Drugs effects may be there

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@Curofy Expert Panel -obesity due to depression medicine

What are the medications?

It could be Cushing's syndrome.

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@Dr. Vavuluru Sudhakarbabu @Dr. Abdul Hameed Ansari

Difficult to say but one had to rule out Cushing syndrome

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