A 54-year-old man comes to the office due to chronic fatigue, decreased concentration, and depressed mood for the past year

A 54-year-old man comes to the office due to chronic fatigue, decreased concentration, and depressed mood for

the past year. The patient sleeps very poorly and awakens multiple times each night. He struggles to get through

his workday because he feels so tired. He has difficulty concentrating on his paperwork and could easily fall

asleep at his desk. He has been arguing with his wife, who is angry that he does not want to be involved in

activities anymore. She recently moved out of the bedroom and is sleeping on the living room couch due to his

loud snoring. The patient does not understand why he feels this way, as he "used to have great energy and was

up for anything." He has a history of hypercholesterolemia and hypertension. He has no known psychiatric

history. His medications include hydrochlorothiazide and lovastatin. The patient drinks alcohol socially and does

not use illicit drugs. He is 175 cm {5 fl 9 in) tall and weighs 118 kg (260 lb); blood pressure is 140/85 mm Hg and

pulse is 78/min. Physical examination shows no other abnormalities. Laboratory values are within normal range.

Mental status examination shows a mildly depressed mood with a full range of affect and no suicidal ideation

Which of the following is the most likely diagnosis in this patient?

Q A Adjustment disorder with depressed mood

Q B. Bipolar disorder, depressed

Q C. Cyclothymic disorder

Q D. Major depressive disorder

Q E. Mood disorder due to another medical condition

Q F. Persistent depressive disorder, dysthymia

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