Isotretinoin, trade name Accutane, is a medication for severe acne vulgaris which was released in 1982. The possible relationship with depression symptoms was first reported in 1983. The FDA issued a warning in 1998 regarding “possible associations of isotretinoin with depression, psychosis, suicidal ideation, and suicide.” (1). Isotretinoin is a fat-soluble compound, crossing the blood-brain barrier, and can affect dopaminergic and serotonergic systems. A 2008 case crossover study published in the Journal of Clinical Psychiatry found a statistically significant association between isotretinoin and depression.
However, a competing viewpoint that treatment of severe acne with isotretinoin actually improves depression symptoms. Several studies have failed to show an increased risk for depression or suicide with isotretinoin.
A more recent meta-analysis published in 2017 did not find any statistically significant or causal relationship. In this study pooled results of 1411 patients who received depression evaluations at baseline and after treatment revealed significant improvement in depression scores. A controlled trial (3) new onset depression was noted in both isotretinoin and antibiotic groups, implying depression is associated with acne. There do not appear to be randomized controlled trials investigating this possible phenomenon.
In sum, there does not appear to be enough data to establish a causal link between isotretinoin and depression, psychosis, or suicide. There may be evidence that treating acne successfully can improve depression, which may be more prevalent in people with severe acne. I would not hesitate to use isotretinoin for a person with severe acne and previously identified depression, but the patient should be made aware of the possible relationship and closely monitored.
Sources:
However, a competing viewpoint that treatment of severe acne with isotretinoin actually improves depression symptoms. Several studies have failed to show an increased risk for depression or suicide with isotretinoin.
A more recent meta-analysis published in 2017 did not find any statistically significant or causal relationship. In this study pooled results of 1411 patients who received depression evaluations at baseline and after treatment revealed significant improvement in depression scores. A controlled trial (3) new onset depression was noted in both isotretinoin and antibiotic groups, implying depression is associated with acne. There do not appear to be randomized controlled trials investigating this possible phenomenon.
In sum, there does not appear to be enough data to establish a causal link between isotretinoin and depression, psychosis, or suicide. There may be evidence that treating acne successfully can improve depression, which may be more prevalent in people with severe acne. I would not hesitate to use isotretinoin for a person with severe acne and previously identified depression, but the patient should be made aware of the possible relationship and closely monitored.
Sources:
- Chang, Yu-Chen et al. Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis. American Academy of Dermatology. 2017
- Bigby, M et al. Does Isotretinoin increase the risk of depression? J Clinical psychiatry. 2008
- Halvorson JA, et al. Suicidal ideation, mental health problems, and social impairment and increased in adolescent swith acen: a population-based study. J Invest Dermatol. 2011.
