Please help?

[aDepressedGuy]

Dear Doctor,
I am a 43 yrs old guy diagnosed with severed depression and anxiety.  I believe my depression could be related to metabolism or fatty liver.  My generalist told me I have high blood preassure. Recent diagnoses and tests came as follows:
Diffuse fatty infiltration of the liver w/o definite focal liver lesion.  No focal lesions in the spleen, gallblader, addrenal glands, pancreas or kidneys.   No renal, ureteral or bladder calculi.  No hydornefrosis.  The right kidney is somewhat malrotated.
No abdominal or pelvic lymphadenopathy.  The bowel is not dilated.  The appendix is unremarkable.  Prostate gland is not enlarged.  No suspicious osseous lesions.
Fatty Liver
The following showed in the abnormal range:
AST 44, ALT 83, LDL 128, %Saturation 51, Ferritin 643, TSH 4.51, Aldolase 9.1
No immunity to Hepatitis B  Virus
I have 3 or 4 lumps of fat in my legs and abdomen.  I’m shedding my  leg’s hair. And  I am 5’ 9” and 195lbs Hispanic/Caucasian.

What do I have?  Is my depression related to the findings above?

Sometimes feel disabled (see below) and call in sick for work.  Am I?

I have Fear of Public Speaking,  “socially challenged”, decreased interests in family, personal, and work related activities, often has difficulties sleeping.  Family issues and son’s  mild autism are big stressors are also big stressors.  

Currently taking the following prescriptions and over the counter medications :
Welbutrin 300MG daily Zoloft150MG daily Ecotrin 81MG daily Zetia 10MG daily Omega 3 2000 MG daily Vitamin C 2000 MG daily Multivitamin daily Propranolol 20-40MG when needed Zanax 1MG when needed
Please help answering my questions above.  Thanks in advance.
Also, I have hemorrhoids and sometimes bleed through the anus when having bowl movement.  Had colonoscopy a while ago and found internal hemorrhoid.  And I used to drink a lot of alcohol in my teens, twenties and early thirties.  Now drink about 1 or 3 beers every 2 or 3 months.

[aDepressedGuy]

With all due respect, but I think the answer you provided is not worth the $16 I paid.  You didn't answer the question I asked.  I want a refund.

[aDepressedGuy]

Dr. Pho,  Thank you for your response.  You basically comfirmed my previouse research regarding fatty liver and hemochromatosis.  I have an appointment next Friday with a gastroenterologist.

I am already seen a psychiatrist.  My request was meant to ask whether or not the findings listed could be a reason/cause for the depression.

Can you help with that please?

Regards,
aDepressedGuy

[Kevin Pho, MD]

The lab findings that you listed should not be a definitive cause of the depression.

The liver enzymes are mildly elevated, and I agree with the ultrasound.  Fatty liver can be caused by alcohol use, or if you don't take alcohol, there is a condition known as non-alcoholic steatohepatitis that can be considered.  If this is suspected, weight loss would be the primary management option.

I also see that the ferritin is markedly elevated as well.  This can be suspicious for hemochromatosis, and if suspected by your doctor, a liver biopsy as well as genetic testing would be the recommended next steps.

I cannot make a determination about disability without an examination.

I would discuss these options with a gastroenterologist. For the other issues, such as management of depression, a referral to a psychiatrist can be considered.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd