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Isotretinoin for acne not associated with increased depression risk

Isotretinoin treatment for acne was not associated with an increased risk for depression, according to recent research published in the Journal of the American Academy of Dermatology.

Researchers in Taiwan noted that although the FDA issued a warning in 1998 regarding possible association of isotretinoin with depression, psychosis, suicidal ideation and suicide, population-based studies in 2000 and 2003 and several other studies failed to demonstrate an increased risk for depression or suicide in association with isotretinoin.

The researchers conducted a systematic review and meta-analysis of studies indexed in PubMed, Medline, EmBase and the Cochrane Library databases from inception of isotretinoin treatment through Sept. 30, 2016.

Thirty-one studies met inclusion criteria, including controlled or noncontrolled trials of at least 15 patients with acne.

The researchers calculated prevalence of depression and change in depression scores.

There was no significant difference between patients receiving isotretinoin and those received an alternative treatment (standardized mean difference [SMD] = –0.334; 95% CI, –0.68 to 0.011) in six controlled studies.

There was a significant decline in prevalence of depression after isotretinoin treatment (RR = 0.588; 95% CI, 0.382-0.904). There also was a significant decrease in mean depression score from baseline (SMD = –0.335; 95% CI, –0.498 to –0.172).

“The relationship between isotretinoin treatment for acne and depression remains controversial both clinically and scientifically,” the researchers wrote. “Because isotretinoin is a fat-soluble compound, it can easily cross the blood-brain barrier and interact with brain tissue whenever intracellular retinoid receptors are present,” the researchers wrote.

The researchers noted that depression symptoms improved after treatment with isotretinoin, but this was not significant compared with alternate therapies.

“Some patients might be more prone to depression, regardless of acne or other conditions,” the researchers concluded. “Thus, closely monitoring acne patients for depression is essential to identify patients at high risk.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.