Graves Ophthalmopathy and Mood Disturbance

We read with interest the article “Psychological Disturbance in Graves Ophthalmopathy” by Farid et al in the April 2005 issue of the ARCHIVES.¹ By using the Profile of Mood States survey, the authors demonstrated that patients with moderate to severe Graves ophthalmopathy (GO) have significant mood disturbances, especially when disfiguring signs are predominant.

Seventeen (23%) of the 74 patients who completed the surveys were excluded because they were currently taking antidepressant medications. According to the third National Health and Nutrition Examination Survey (1988-1994),² only 2.3% of adults in United States reported using antidepressant medications during a 1-month period. The 2002 National Ambulatory Medical Care Survey³ reported similar findings, in which 4.5 antidepressant medications were mentioned per 100 office-based physician visits. The higher proportion of patients taking antidepressant medications in this study may support the findings of the study that patients with moderate to severe GO have more mood disturbances, and are thus more likely to take antidepressant medications. Another possible explanation is selection bias that depressed patients may be more willing to participate in the study for the extra medical attention. Additional information about the underlying causes of depression of these 17 patients would be beneficial in interpreting the study results.