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Old 09-25-2012
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Default 62-yr old man feeling ''depressed''

A 62-year-old man complains that he is feeling
“depressed.” He says that over the past 2 years,
he has begun to have a vague feeling of sadness.
In addition, he notes that he is extremely fatigued
during the day, frequently nodding off to
sleep at work. Before going to work, he frequently
takes ibuprofen to relieve nearly daily
morning headaches. When asked about changes
in his life over the past 2 years, he reports that
he has gained a signifi cant amount of weight
due to “job stress.” Further questioning reveals
that he does not feel guilty, has no suicidal ideation,
and still enjoys his favorite pastime of
reading mystery novels and holding a biweekly
book club with friends. The patient’s body mass
index is 42 kg/m˛. Results of physical examination
are within normal limits. Which of the following
is most appropriate for this patient?

(A) Methylphenidate
(B) Modafi nil
(C) Sertraline
(D) Thyroid hormone replacement
(E) Weight loss and continuous positive airway
pressure
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Old 09-25-2012
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Answer E .He has obesity hypoventilation syndrome or Pickwinian syndrome .The high CO2 is causing the headache .Poor sleep is causing him sleepiness during the day and also depression.
The dude needs to shed some weight
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Old 09-26-2012
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(E) Weight loss and continuous positive airway
pressure

Obesity with sleep apnoea..
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