Publications

Published: September 2011

Acne, isotretinoin and depression - inform and monitor

Prescriber Update 32(3): 25-26
September 2011

Prescribers are reminded that all patients treated with isotretinoin need to be informed of the risk of depression and be monitored for the development of depression during treatment.

Isotretinoin is approved for use in the treatment of severe forms of nodulo-cystic acne that are resistant to other treatment. Isotretinoin should only be prescribed by prescribers who are experienced in the use of isotretinoin and understand the risk of teratogenicity.

An association between the use of isotretinoin and the development of depression and/or suicidal ideation was first identified from case reports and published case series. Subsequent epidemiological studies have reported conflicting results.1 In many cases, confounding factors such as the high prevalence of psychiatric morbidity in adolescents and patients with acne are present and make causality assessment difficult.2

A recent study conducted in New Zealand found that mood change occurred in 5-10% of patients taking isotretinoin with the incidence increasing with larger doses.3

A recent Swedish cohort study reported a positive association between the use of isotretinoin and suicide attempts.4 This study found that the risk began to increase two years before starting isotretinoin and peaked six months after stopping treatment. In addition the risk was greatest in patients receiving repeated courses of isotretinoin, suggesting it might be related to the patients’ perception of their underlying acne.

Further information is available in the isotretinoin datasheet at: www.medsafe.govt.nz/Medicines/infoSearch.asp

Key messages:

  • Patients with acne are at risk of developing depression and/or suicidal ideation.
  • All patients treated with isotretinoin should be monitored for symptoms of depression.
  • Patients (and parents or caregivers) should be informed of the risk of depression and/ or suicidal ideation.
  • Patients should be advised to seek medical advice immediately if these symptoms occur even after isotretinoin has been discontinued.
  • Simply stopping isotretinoin treatment may not relieve the symptoms of depression; additional treatment may be required for some patients.
References:
  1. Magin P and Sullivan J .2010. Editorial. Suicide attempts in people taking isotretinoin for acne. BMJ; 341: c5866 doi:10.1136/bmj.c5866
  2. Halvorsen JA and Sterm RS et al .2011. Suicidal Ideation, Mental Health Problems, and Social Impairment Are Increased in Adolescents with Acne: A Population –Based Study. Journal of Investigative Dermatology 131: 363-370.
  3. Rademaker M .2010. Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoin. Australasian Journal of Dermatology 51: 248-253
  4. Sandstorm A et al .2010. Association of suicide attempts with acne and treatment with isotretinoin; retrospective Swedish cohort study. BMJ 201; 341:c5812doi:10.1136/bmj.c5812.