Isotretinoin and antidepressant pharmacotherapy: a prescription sequence symmetry analysis

J Am Acad Dermatol. 2003 Sep;49(3):424-32. doi: 10.1067/s0190-9622(03)02087-5.


Background: Isotretinoin is indicated for the treatment of severe, recalcitrant nodular acne. Spontaneous reports have suggested a possible association between isotretinoin and depression that has not been supported by prior studies. Depression has been reported in patients with acne and is common among adolescents.

Objective: The objective of this study was to investigate whether there is an association between isotretinoin use and onset of depression.

Methods: A large retrospective database study was performed through a review of pharmacy claims to evaluate the order of first-recorded isotretinoin and antidepressant dispensings in incident users. The study included 2821 patients, aged 12 to 49 years, who filled isotretinoin prescriptions between June 1, 1999, and March 31, 2000. The ratio of the number of patients who filled isotretinoin prescription first versus second was computed, with adjustment for variations in physician prescribing patterns; a ratio significantly greater than 1.0 indicates a depression-invoking relationship. Similar analyses of minocycline were performed.

Results: Adjusted ratios for all antidepressants and by class were not significantly greater than 1.0. Similar results were found for minocycline.

Conclusion: The results do not support an association between the use of isotretinoin and the onset of depression.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Acne Vulgaris / diagnosis
  • Acne Vulgaris / drug therapy
  • Adolescent
  • Adult
  • Adverse Drug Reaction Reporting Systems
  • Age Distribution
  • Antidepressive Agents / therapeutic use*
  • Child
  • Cohort Studies
  • Confidence Intervals
  • Depressive Disorder / chemically induced*
  • Depressive Disorder / drug therapy
  • Depressive Disorder / epidemiology
  • Dermatologic Agents / administration & dosage
  • Dermatologic Agents / adverse effects
  • Drug Prescriptions / statistics & numerical data*
  • Drug Therapy
  • Drug Utilization
  • Female
  • Humans
  • Incidence
  • Isotretinoin / administration & dosage
  • Isotretinoin / adverse effects*
  • Male
  • Middle Aged
  • Minocycline / administration & dosage
  • Minocycline / adverse effects*
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution


  • Antidepressive Agents
  • Dermatologic Agents
  • Isotretinoin
  • Minocycline