There are a number of physical illnesses and medical conditions
where depression is a side effect; for example, thyroid problems.
That's why a competent medical doctor runs a battery of tests
before concluding that antidepressant medication is the
appropriate treatment.

But if your wife isn't _feeling_ depressed, it seems odd to me
that her doctor could conclude that her weight loss and fatigue
are purely symptoms of clinical depression. I mean, they're also
side effects of a lot of other conditions, and not all of those
show up in the standard blood tests.

I think that in this situation, a second opinion is called for.
Preferably someone who has no connection with your current
doctor.

Tara J. Ballance
Montreal, Canada

Depends on whether she's also eating less, which wouldn't be
surprising.

But why does her doc insist on trying Prozac first?  There are a lot
of antidepressants, and Prozac would not necessarily be the best
choice for an individual.  If the doc isn't a psychopharmacologist,
I'd like to know the rationale.

(Personally, I wouldn't take Prozac.  It destroys your libido.  I'd
try something less inhibiting first.)

 -- David Wright :: alphabeta at prodigy.net
    These are my opinions only, but they're almost always correct.
    "If you can't say something nice, then sit next to me."
                                -- Alice Roosevelt Longworth

Constant fatigue by itself does not constitute depression. It might
conceivably be a condition that would benefit from an antidepressant
medication for reasons unrelated to depression as such, but it
wouldn't be depression. Depression, by definition, has *depressed
mood* as a major defining issue.

I can't think of any reason why Prozac would result in her having more
energy, if her lack of energy isn't a side effect of depression. This
doesn't sound right to me.

I would look at endocrine problems first off. You mention a doctor and
"blood tests," but not what kind of doctor. Anemia is an obvious one,
but that's easy to detect, and it sounds like the doctor looked for
it. There are a variety of possible thyroid problems that can cause
fatigue, although the combination of fatigue and weight loss sounds
more like hyperthyroidism than hypothyroidism to me.

How is her sleep? Poor sleep from apnea or other breathing problems
can cause terrible fatigue, though not obviously weight loss.
Hyperthyroidism can also cause poor sleep, and seems to me a more
likely explanation than apnea (though if she sleeps poorly and it
isn't due to hormone problems, then she should visit a sleep clinic
for diagnosis).

I hate to say it, but she might also be a candidate for Chronic
Fatigue Syndrome, although you don't mention any of the other
symptoms.

I would *strongly* suggest that she see an endocrinologist (not a GP)
for a thorough study of her endocrine system. See where that leads
you. If that fails, and she sleeps badly, then visit a sleep clinic.
If she has no endocrine problems and does not have apnea, then a
*stimulating* antidepressant might help with the energy problem, but
that's some ways down the line. I wouldn't want to start there.

But Prozac? That makes no sense to me.