Psychiatric reactions to isotretinoin in patients with bipolar disorder

Schaffer, Linda C.; Schaffer, Charles B.; Hunter, Susan; Miller, Amber R.

doi:10.1016/j.jad.2009.09.005

Cited by 48 publications

(27 citation statements)

References 14 publications

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“…Three patients attempted suicide at some time after initiation of treatment. 78 This drug may also exacerbate pre-existing psychiatric conditions; 62, 68, 76 for instance, Schaffer et al 81 examined the charts of 300 patients with bipolar disorder. Ten of the patients were found to have been treated with isotretinoin.…”

Section: Resultsmentioning

confidence: 99%

Retinoic Acid and Affective Disorders

Bremner¹,

Shearer²,

McCaffery³

2011

J. Clin. Psychiatry

171

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Objective Isotretinoin (13-cis-retinoic acid, or 13-cis-RA) (Accutane), approved by the FDA for the treatment of acne, carries a black box warning related to the risk of depression, suicide, and psychosis. Retinoic acid (RA), the active form of vitamin A, regulates gene expression in the brain, and isotretinoin is its 13-cis isomer. Retinoids represent a group of compounds derived from vitamin A that perform a large variety of functions in many systems, in particular the CNS, and abnormal retinoid levels can have neurological effects. Although infrequent, proper recognition and treatment of psychiatric side effects in acne patients is critical given the risk of death and disability. This paper reviews the evidence for a relationship between isotretinoin, depression and suicidality. Data Sources Evidence examined includes: 1) case reports; 2) temporal association between onset of depression and exposure to the drug; 3) challenge-rechallenge cases; 4) class effect (other compounds in the same class, like vitamin A, having similar neuropsychiatric effects); 5) dose response; and 6) biologically plausible mechanisms. Study Selection All papers in the literature related to isotretinoin, depression and suicide were reviewed, as well as papers related to class effect, dose response, and biological plausibility. Data Extraction Information from individual articles in the literature was extracted. Data Synthesis The literature reviewed is consistent with an association between isotretinoin administration, depression and suicide in some individuals. Conclusions The relationship between isotretinoin and depression may have implications for a greater understanding of the neurobiology of affective disorders.

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Section: Resultsmentioning

confidence: 99%

Retinoic Acid and Affective Disorders

Bremner¹,

Shearer²,

McCaffery³

2011

J. Clin. Psychiatry

171

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“…Concerning the relationship between isotretinoin and the potential for subsequent onset of psychopathology, positive dechallenge and rechallenge cases have been reported, prompting physicians to look out for the onset or worsening of psychiatric symptoms, including bipolar disorder 10,13. Nonetheless, the neurotoxicity of the synthetic retinoic acid analogs is supported by a considerable body of literature.…”

Section: Discussionmentioning

confidence: 99%

“…Remarkably, when affective psychosis and obsessive-compulsive disorder (OCD) occur following isotretinoin treatment, associated psychopathology is generally severe and eventually poorly responsive to conventional treatment, as highlighted by recent, large, retrospective studies 3. Also, although patients suffering from bipolar disorder may be at increased risk for mood symptom exacerbations due to isotretinoin therapy, including suicidal ideation, even with a concurrent antimanic therapy,3 less is known about the risk for developing ex novo affective psychosis and antidepressant manic vulnerability when isotretinoin treatment is used during adolescence.…”

Section: Introductionmentioning

confidence: 99%

“…Also, although patients suffering from bipolar disorder may be at increased risk for mood symptom exacerbations due to isotretinoin therapy, including suicidal ideation, even with a concurrent antimanic therapy,3 less is known about the risk for developing ex novo affective psychosis and antidepressant manic vulnerability when isotretinoin treatment is used during adolescence. Furthermore, acne itself often occurs during adolescence, and can be eventually induced by lithium, a standard treatment for bipolar disorder, which, in turn, usually has its onset at the same age.…”

Section: Introductionmentioning

confidence: 99%

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Obsessive-compulsive disorder with bipolar diathesis following isotretinoin therapy remitting upon treatment with olanzapine and fluvoxamine

Fornaro¹

2010

NDT

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Isotretinoin, a drug used for moderate to severe acne, has been repeatedly associated with various psychiatric complications, although a definitive causal relationship has not been established to date. This case report describes a 25-year-old male who developed obsessive-compulsive disorder at the age of 23 years following isotretinoin treatment for acne (10–20 mg/day) since the age of 16 years. Although standard treatment for obsessive-compulsive disorder caused mood swings, the combination of fluvoxamine 300 mg/day and olanzapine 15 mg/day significantly improves the clinical picture. Although rare, severe adulthood psychiatric complications may occur following isotretinoin treatment, requiring management which is individually tailored to the patient.

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“…Bipolar bozukluk tan›s› olan ve isotretinoin tedavisi bafllanan 10 hastan›n dahil edildi¤i bir ça-l›flmada alt› hastada kar›fl›k duygudurum semptomlar›, ikisinde depresif semptomlar ve birinde hipomanik semptomlar görülmüfltür. Befl hasta isotretinoin tedavisini psikiyatrik yan etkiler nedeniyle tamamlayamam›flt›r 18 . Barak taraf›ndan yap›lan ve isotretinoin kullanan 500 askerin dahil edildi¤i çal›fl-mada ise befl askerde "manik psikoz" gözlenmifltir, bu hastalar›n soygeçmifl bilgilerine bak›ld›¤›nda üçünün birinci derece akrabalar›nda bipolar bozukluk tan›s› bulunmufltur 19 .…”

Section: ‹Sotretinoinunclassified

Psychiatric Adverse Effects of Dermatological Drugs

Ozmen¹,

Çetin²

2010

turkderm

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Psychiatric reactions to isotretinoin in patients with bipolar disorder

Cited by 48 publications

References 14 publications

Retinoic Acid and Affective Disorders

Retinoic Acid and Affective Disorders

Obsessive-compulsive disorder with bipolar diathesis following isotretinoin therapy remitting upon treatment with olanzapine and fluvoxamine

Psychiatric Adverse Effects of Dermatological Drugs

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