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When presented with a disease profile of fatigue, loss of appetite, weight loss and depression, most of my colleagues and I can agree that it would be easier to determine what came first, "the chicken or the egg" rather than to figure out the hundreds of underlying possibilities that could be at play with a cluster of non-specific findings like that. 

Nevertheless, physicians are always up for a good challenge and this may be one of the most common ones we face in the wards daily. Let me explain a little of the thought process that goes behind trying to figure out what is the cause of symptoms. To start off with, rather than going on "wild goose hunts" by ordering numerous tests trying to explore all possibilities for the symptoms alone, a good physician will try to think of the diseases on a more digestible level by thinking of diseases that can lead to all those types of symptoms. 

Unfortunately, that is easier said than done because almost all diseases can have at least two of the elements in the diagnosis. That is why doctors need to sit down with the patient and ask a detailed history and perform a full physical exam in order to narrow down the investigation. Even after a 10-minute conversation, doctors will be able to ascertain if this is a psychological, organic or combination of both and direct the patient down more directed investigations to determine what is happening.  Lab checks like blood count and morphology are great at determining if doctors are going in the right direction and can be done in a matter of minutes.  

Stress disorders are conditions that do not require the same deep medical exploration that other conditions may call for and are some of the most straightforward to treat. If a patient is suffering from depression due to a previous condition, there is a good chance that they will present with fatigue, loss of appetite and weight loss. Doctors will need to ask a detailed past history to determine if there was some significant event in the past in order to lead to depression. 

Another possible stress disorder that could manifest with all these conditions would be anxiety. Due to the fast-paced lifestyle seen in Western society, patients can easily become exhausted from simply doing too much and that can lead to depression. If you become used to skipping meals, you will naturally become thinner and may lose the drive to eat more if you habitually skip meals. 

An organic cause of depression, fatigue, weight loss and even loss of your appetite could be due to an overactive thyroid. This is an endocrine gland that is responsible for regulating your metabolism. When thyroid hormone levels are extremely elevated, it is entirely possible that the patient will present with fatigue, loss of appetite, changes in mood and even significant weight loss. This can be easily ruled out with a simple blood test checking your thyroid hormones T3 and T4. 

As you can see, presenting with very vague symptoms like fatigue, weight loss, depression and loss of appetite are not enough to have a definitive diagnosis in a matter of moments. Patients should immediately go to their family doctor and explain these symptoms in more detail and get tested to determine what is the likely cause of this condition. 

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