54-year-old man with weight gain and muscle weakness

History of Present Illness

A 54-year-old man comes to the office because of a 10-kg weight gain in the past 3 months despite no significant change in his diet. He also reports bilateral leg weakness, especially when standing up from sitting or when climbing stairs. On questioning, he complains of lethargy and difficulty in getting up in the morning despite getting 8 hours of sleep. He was recently diagnosed with type 2 diabetes and was started on metformin; however, good glycemic control has not been achieved. At a visit 2 months ago, he also complained of low mood for which citalopram was prescribed but with no significant improvement. He tells you today that his wife has left him because she could not tolerate his lack of motivation and mood swings.