Severe Malnutrition Revealing Psychotic Depression in an Elderly Patient Successfully Treated With Electroconvulsive...

Depression in older adults can sometimes present mainly with physical symptoms. This may delay recognition of the underlying psychiatric illness. We describe a 74‑year‑old man admitted to a medical ward with severe malnutrition caused by almost complete refusal of food. Extensive medical investigations did not reveal an organic cause. The patient was initially treated with antidepressant medication and nutritional support. However, his condition continued to deteriorate. A second psychiatric assessment identified severe psychotic depression with impaired decision‑making capacity and starvation syndrome. The patient was transferred urgently to a psychiatric unit and treated with bilateral electroconvulsive therapy (ECT). Following treatment, there was rapid improvement in mood, engagement, and oral intake. This case highlights the importance of reconsidering psychiatric diagnoses when medically unwell patients fail to improve and demonstrates the effectiveness of ECT in severe late‑life depression.