Gero Case

how long has this been going on? I would be thinking most likely post-surgical depression possibly with exacerbation or unmasking of underlying cognitive impairment. I would do a MoCA or other cognitive screen if not already done, and do an 3T MRI Brain with neuroquant analysis. Consider neuropsychological testing. I might also consider an awake/drowsy EEG if concerns about subclinical seizures. EEG may also reveal diffuse cortical slowing in keeping with a dementing or encephalopathic process.

depression following surgery is typically self-limiting but can last up to 6 months. the stress of surgery, the meaning of the procedure, the loss of health and functioning may contribute but it is generally believed to be associated with massive cytokine and other inflammatory marker release which can lead to significant depressed mood, fatigue, anorexia and so on.

I would be tempted to trial low dose methamphetamine which I have had some good success with in older patients including post-operative. it actually can stimulate appetite in these patients including increasing energy and motivation. I typically start at 2.5mg bid and go from there.

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Gero Case