Case Report of Severe Weight Loss Possibly Associated with Methylphenidate

Abstract

Objective:

To document a case of severe weight loss in an adult depressed patient being treated with methylphenidate, nefazodone, and electroconvulsive therapy (ECT).

Case Summary:

A 57-year-old white, postmenopausal, nonsmoking, retired nurse with major depressive disorder (status post-ECT) presented to her internist with an involuntary weight loss of >21 kg over six months. Medications included aspirin, hydrochlorothiazide, nefazodone, docusate sodium, methylphenidate, salsalate, and conjugated estrogen. An extensive workup included colonoscopy, abdominal computed tomography (CT) scan, head CT scan, chest X-ray, pelvic ultrasound, Pap smear, mammogram, thyroid function tests, liver function tests, serum electrophoresis, and serum chemistries. All test results were unremarkable.

Discussion:

Methylphenidate was eventually suspected to be contributing to the sudden weight loss in our patient, due to its anorexic effects and a temporal association between the initiation of this drug and the weight loss. However, a MEDLINE search of adverse effects associated with methylphenidate did not identify reports of weight loss of this magnitude. Moreover, published reviews of psychostimulant treatment in adult patients with depressive disorders indicate that anorexia and weight loss are usually not observed.

Conclusions:

This case associates the use of methylphenidate, nefazodone, and ECT for the treatment of depression with significant weight loss in an adult. As the differential diagnosis for involuntary weight loss is expansive, secondary causes such as medications should be considered as possible cofactors precipitating weight loss.