Prospective study of depressive symptoms and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy

Abstract

There have been recent concerns about the possible association between isotretinoin therapy and depressive symptoms. We conducted a prospective study to evaluate depressive symptoms and quality of life in acne patients having either isotretinoin or antibiotics/topical treatments. There were 215 patients (mean age 20 years) included in the study. Depression, quality of life and acne severity ratings were administered at baseline, 1 month, 3 months and end of treatment or 6 months, and compared between both treatment groups. The changes in the mean depression scores did not differ significantly between both groups (P = 0.62). The incidence of isotretinoin patients with moderate depressive symptoms remained relatively unchanged from baseline. The changes in the quality-of-life measures scores between treatment groups showed no significant difference. No correlation between isotretinoin dose and depression score was found. Although five isotretinoin patients were withdrawn during the study because of worsening of mood, no definite causal relationship was established. This pilot study does not appear to support any direct link between depression and isotretinoin, apart from being a rare unpredictable idiosyncratic side-effect. However, because of the study limitations, a larger study is needed to confirm the findings.

The neurobiology of retinoic acid in affective disorders

“…Other authors reported an onset of symptoms at two months after start of treatment (Bigby and Stern 1988;Burket and Storrs 1987;Hepburn 1990;Lindemayr 1986). Most of the other cases developed depression or committed suicide at some point during treatment (2-4 months after onset of treatment) although specific details are not always given (Barak et al 2005;Bravard et al 1993;Byrne and Hnatko 1995a;Cotterill and Cunliff 1997;Ng et al 2002;Scheinman et al 1990;Wysowski et al 2001b). Of course it is always possible (especially in the suicide cases) that symptoms were not reported at the time they actually started, or that patients denied depression.…”

“…One of the patients was rechallenged with isotretinoin and experienced a recurrence of symptoms 3 months after re-initiation of treatment. Several other authors have reported individual cases of abatement of symptoms of depression and/or suicidality after discontinuation of isotretinoin (Bigby and Stern 1988;Bravard et al 1993;Burket and Storrs 1987;Byrne and Hnatko 1995b;Duke and Guenther 1993;Ng et al 2002). For instance, Barak reported that 4/5 patients who developed psychosis after receiving isotretinoin had an improvement in symptoms with cessation of isotretinoin and treatment with antipsychotics (Barak et al 2005).…”

The Relationship Between Perception of Disease and Quality of Life in Patients with Acne Vulgaris from 2013 to 2014

“…On the other hand there is a significant relation between disease and quality of life, so that people who have more severe disease, had higher quality of life scores suggesting quality of life disorder. There is no significant relation between acne severity and quality of life in Matsoka's et al study, but there is a significant relation between lesions severity and patients quality of life in Hong's et al study, in Cobaler's et al study and in Yazirey's et al study (14)(15)(16)(17). Patients who have more severity had higher scores in quality of life they have reported more anxiety and depression.…”

Anxiogenic and depressogenic side-effects of non-psychiatric drugs

“…Összességében a fennálló eredmények alapján csak kismértékben hozható összefüggésbe a depresszió az izotretinoin szedésével. A gyógyszer hatékonysága magasabb, mint 75%, ugyanakkor az alkalmazását mindenképpen mérlegelni szükséges, nemcsak depressziót okozó hatása miatt, hanem magas teratogenitása és egyéb mellékhatásai, például száraz bőr, fotoszenzitivitás, letargia, megváltozott májfunkcióértékek miatt is [60].…”