Isotretinoin Use and Risk of Depression in Acne Vulgaris Patients in Riyadh, Saudi Arabia

Abstract

Background The association between isotretinoin administration and depression in acne patients remains controversial. We aim to estimate the prevalence of depression among patients with acne vulgaris before and after treatment with isotretinoin in Riyadh, Saudi Arabia. Methods This was a prospective study on patients attending the King Khalid University Hospital (KKUH), a tertiary institution, who were prescribed isotretinoin for the treatment of acne vulgaris for the first time. The Beck Depression Inventory (BDI) was used to screen for depressive symptoms. Results A total of 179 patients were included in the study. The patients were then divided into two groups based on the treatment modality that they received: one group taking isotretinoin and the other treatment group who used other medications, including Retin-A (tretinoin) and Tazorac (tazarotene). A total of 119 patients were in the isotretinoin group with 91.6%, 2.5%, 1.7%, and 3.4% of those patients having a normal mood, mild depression, moderate depression, and severe depression scores before starting isotretinoin treatment, respectively. After three months of treatment, 94.1%, 1.7%, 0.8%, and 2.5% of patients had normal mood, mild depression, moderate depression, and severe depression, respectively. Meanwhile, after six months of treatment, 95.8%, 0.8%, 0%, and 1.7% of patients had normal mood, mild depression, moderate depression, and severe depression, respectively. The mean BDI score at the baseline was 3.31 ± 6.98 for isotretinoin and 3.17 ± 6.27 for other treatments. Compared to the baseline, patients using the isotretinoin showed a significant reduction in depression scores at three months (2.64 ± 6.17; p-value < 0.001), six months (1.99 ± 5.08; p-value < 0.001), and across all follow-up points (p-value < 0.001). Similar results were also estimated for the other treatment group, including Retin-A (tretinoin), adapalene, benzoyl peroxide, and doxycycline; however, no significant difference was noticed between the two groups (p-value = 0.885). Conclusion Isotretinoin treatment for acne does not appear to be associated with a statistically significant increased risk of depression in our population. Therefore, more studies are needed to understand this reflection in Saudi Arabia.

The Social and Psychological Impact of Acne Treatment: A Cross-Sectional Study of Blood Donors

“…37 This fear has now largely been put to rest, as acne patients treated with isotretinoin do not appear to have an increased risk of depression. 38,39 Our results confirm that patients with untreated acne have a numerical trend for increased risk of depression. The interpretation of these results is further dependent on the minimal clinically important difference (MCID).…”

Isotretinoin treatment and risk of depression in acne vulgar patient: what is the evidence?

“…This evidence-based review demonstrated that treatment of acne patients with isotretinoin does not appear to be related to the development of depression, with a strength of recommendation of A 3,4,[6][7][8] . We further conclude that treatment of acne, regardless of chosen drug, seems to improve depressive symptoms 3,6,7 . More studies, such as randomized clinical trials or other prospective studies with larger sample sizes, are needed to confirm these findings.…”

“…After a detailed analysis of the included studies, we found that there is no evidence that isotretinoin is associated with depression 3,4,[6][7][8] .…”

“…Alghofaili et al 7 performed a prospective cohort study in Saudi Arabia, which included 179 patients of whom 119 were treated with oral isotretinoin, at a daily dose of 0.5 mg/kg, and 60 with different topical treatments (tretinoin or tazarotene). The Beck depression inventory scale was applied before 3 and 6 months after the start of treatment.…”

Effect of Systemic Isotretinoin Treatment on Depression and Other Psychological Symptoms: A Case-Control Study

“…Topical treatments, especially topical retinoids, are preferred for mildly severe cases, and systemic regimens that include antibiotics, hormonal treatment, and oral retinoids are used in moderate and severe cases. 3…”