New psychiatric symptoms lower in adolescents receiving isotretinoin than previously shown

Key takeaways:

• 16.2% of patients received a new diagnosis or experienced a psychiatric symptom during treatment.
• After receiving a new psychiatric diagnosis, only 25.5% of patients changed their dosage.

A large proportion of adolescent patients treated with isotretinoin for acne had a history of a psychiatric diagnosis, but most were not diagnosed with additional psychiatric diagnoses or symptoms during treatment, according to a study.

As Healio previously reported, isotretinoin treatment is not linked to an increased risk for suicide or psychiatric conditions among patients aged 16 to 38 years. However, the study maintains that the data continue to be sparse regarding isotretinoin’s impact among adolescents.

“Data remain conflicting regarding isotretinoin’s impact on psychiatric outcomes compared to antibiotic treatment, though it appears that any psychiatric complications are rare and time-limited,” Keith Miller, MD, a psychiatrist in the division of child and adolescent psychiatry at the Mayo Clinic, and colleagues wrote. “These conflicting results, relative dearth of studies and concern of worsening mental health have led to therapeutic timidity when considering isotretinoin for adolescent patients with a psychiatric history.”

To add to the isotretinoin literature for adolescents with acne, the authors conducted a retrospective cohort study. The study was comprised of 606 patients aged 12 to 18 years (mean age, 16 years; 69% male) who were prescribed isotretinoin over a 10-year period between Jan. 1, 2008, and Dec. 31, 2017.

Results showed that 29.2% (95% CI, 25.6%-33%) of patients had a psychiatric diagnosis prior to isotretinoin treatment — a proportion that the authors describe as higher than previously thought.

Patients with a psychiatric history were not more likely to receive a new psychiatric diagnosis as those without a history (4.5% vs. 3.7%), but they did experience more psychiatric symptoms, particularly low mood and mood swings (23.7% vs. 7.7%; P < .001).

On the other hand, among patients without a mental health history, only 16.2% (n = 98; 95% CI, 13.3%-19.4%) received a new diagnosis or experienced a psychiatric symptom during treatment. Of these 98 patients, only 25.5% changed their dosage upon presentation of these new symptoms.

The researchers found that the decision to change isotretinoin dosage was not influenced by a history of psychiatric disorders but was influenced by a new psychiatric diagnosis (41.7% vs. 20.3%; P = .037) and a lack of alternative explanation for symptoms (34.4% vs. 10.8%; P = .009).

“A new psychiatric diagnosis during isotretinoin treatment does predict the dose being changed or stopped, indicating the importance of continuing to clarify whether this medication is associated with psychiatric symptoms beyond those associated with acne itself,” the authors concluded.