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Depression and dementia have a very intimate relationship and hence differentiating the two can be technically challenging. Severe depression can masquerade as dementia and it is therefore extremely important to differentiate between these two as it can impact the management. A patient was admitted with acute confusion, poor mobility and poor oral intake and was initially treated for Urinary Tract Infection (UTI). However, as confusion remained fluctuant, patient was started on treatment for presumed encephalitis. Due to poor response treatment was withdrawn. Patient was then referred to gastroenterology department for consideration of enteral feeding due to malnourishment secondary to confusion and possibly dementia. However, on further assessment a psychiatric opinion was sought and as expected a diagnosis of severe depression was made and hence Electroconvulsive Therapy (ECT) was proposed. Patient made a remarkable recovery with ECT and was subsequently discharged to a rehab facility. With prompt recognition of symptoms patient avoided enteral feeding which made a great difference in overall recovery.