Prevalence of depression in women with endometriosis

Sir, We read with interest the article by Lorencatto et al. evaluating the prevalence of depression in women with endometriosis with and without chronic pelvic pain (1). Although the authors should be congratulated for their findings, we would like to bring to your attention some methodological concerns that have arisen and may deserve further discussion. The authors stated that patients who had undergone surgical treatment of endometriosis were excluded from the study. Although this inclusion criterion may have strengthened the findings of the study, it would be interesting to know how the diagnosis of endometriosis was made. For a definitive diagnosis of endometriosis, visual inspection of the pelvis at laparoscopy is the “gold standard” investigation, unless disease is visible in the vagina or elsewhere (2). Did the patients included in the study have a diagnostic laparoscopy confirming the presence of endometriosis? The authors correctly pointed out that the use of gonadotrophin-releasing hormone analog (GnRH-a) may be associated with depression (3–5); however, they did not report the prevalence of depression in the two study groups excluding from the analysis subjects under GnRH-a. We believe that this data would be useful in our understanding of the psychiatric side effects that may be caused by the administration of GnRH-a to women with endometriosis. In addition, it would be interesting to know whether, in the two study groups, the use of GnRH-a was associated with higher Beck Depression Inventory (BDI) scores.