Association of Isotretinoin With Depression and Suicide: A Review of Current Literature

Abstract

Acne vulgaris, a condition that can affect people at any age, is the most common cause of referral to a dermatologist. Isotretinoin (ITT) is the most effective treatment available, but serious adverse effects, including a possible association with depression and suicide, limit its use. We review the current literature regarding the association of ITT with depression and suicide. Case reports and database studies show a clear association, and this association is biologically plausible. Although prospective studies have opposite results, limitations make them unsuitable to identify a subgroup of patients who may be at risk of developing depression or suicidal ideation with ITT. Overall, it seems some people might be at risk, particularly those with a personal or family history of mental disorder, but further studies are needed to identify those patients who would benefit from an early referral to a mental health professional when ITT is initiated. Currently, no conclusions can be drawn, and it seems appropriate to regularly screen all patients on ITT for depressive symptoms and suicidal ideation and promptly refer them to a mental health professional if any are found.

Does isotretinoin cause depression and anxiety in acne patients?

“…Overall, case reports, database studies, and retrospective studies show a possible association between isotretinoin and depression (Hazen et al, ; Hull & D'Arcy, ; Oliveira, Sobreira, Velosa, Telles Correia, & Filipe, ; Scheinman et al, ). Prospective studies, on the other hand, show no association or, in some studies, improvement of depressive symptoms.…”

Perceptions about oral isotretinoin treatment

“…Psychological side effects were the third most common side effect, which is known by the patients. It is clear that there is a relationship between OIT and depression (Oliveira, Sobreira, Velosa, Telles Correia, & Filipe, ). It is likely that patients with a personal or familial history or other genetic predisposition for psychiatric disorder are more at risk of depression under OIT (Goodfield et al, ; Oliveira et al, ).…”

“…It is clear that there is a relationship between OIT and depression (Oliveira, Sobreira, Velosa, Telles Correia, & Filipe, ). It is likely that patients with a personal or familial history or other genetic predisposition for psychiatric disorder are more at risk of depression under OIT (Goodfield et al, ; Oliveira et al, ). However, the psychological effects of acne vary from depression and anxiety at work and interpersonal disorders and studies using quality of life tools have shown that OIT significantly increases socialization and self‐esteem.…”

“…However, the psychological effects of acne vary from depression and anxiety at work and interpersonal disorders and studies using quality of life tools have shown that OIT significantly increases socialization and self‐esteem. It is important to understand that risk factors for this side effect may be directed at psychiatric evaluations before and during treatment with under OIT (Oliveira, Sobreira, Velosa, Telles Correia & Filipe, ). Other commonly known side effect in the study was exacerbation of acne lesions.…”

“…Oliveira, Sobreira, Velosa, Telles Correia, & Filipe, 2018). It is likely that patients with a personal or familial history or other genetic predisposition for psychiatric disorder are more at risk of depression under OIT(Goodfield et al, 2010;Oliveira et al, 2018).However, the psychological effects of acne vary from depression and anxiety at work and interpersonal disorders and studies using quality of life tools have shown that OIT significantly increases socialization and self-esteem. It is important to understand that risk factors for this side effect may be directed at psychiatric evaluations before and during treatment with under OIT(Oliveira, Sobreira, Velosa, Telles Correia & Filipe, 2018).…”