Isotretinoin and the risk of psychiatric disturbances: A global study shedding new light on a debatable story

J Am Acad Dermatol. 2023 Feb;88(2):388-394. doi: 10.1016/j.jaad.2022.10.031. Epub 2022 Oct 20.

Abstract

Introduction: Isotretinoin-related risk of depression and suicidal behavior is a topic of inconclusiveness. A crucial knowledge gap exists in defining the association of isotretinoin with other psychiatric comorbidities.

Objective: To evaluate the risk of psychiatric outcomes among patients with acne treated with isotretinoin versus oral antibiotics.

Methods: A global population-based retrospective cohort study enrolled 2 groups of patients with acne managed by isotretinoin (n = 75,708) and oral antibiotics (n = 75,708). Patients were compared regarding the risk of 9 psychiatric outcomes.

Results: Relative to those treated with oral antibiotics, patients prescribed isotretinoin experienced lower risk of depression (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.87-0.93; P < .001), but comparable risk of major depressive disorder (HR, 0.97; 95% CI, 0.92-1.03; P = .318). Risk of suicidal attempts was comparable between groups (HR, 0.97; 95% CI, 0.85-1.11; P = .663), despite the elevated risk of suicidal ideation in those under isotretinoin (HR, 1.41; 95% CI, 1.32-1.50; P < .001). Patients under isotretinoin had lower risk of post-traumatic stress disorder (HR, 0.75; 95% CI, 0.68-0.82; P < .001), anxiety (HR, 0.84; 95% CI, 0.82-0.87; P < .001), bipolar disorder (HR, 0.65; 95% CI, 0.59-0.72; P < .001), schizophrenia (HR, 0.60; 95% CI, 0.48-0.76; P < .001), and adjustment disorder (HR, 0.82; 95% CI, 0.77-0.87; P < .001).

Limitations: Retrospective data collection.

Conclusion: Isotretinoin confers lower risk of 6 psychiatric comorbidities and comparable risk of suicidal attempts.

Keywords: Acne; depression; isotretinoin; oral antibiotics; psychiatric disturbances; suicidal attempt; suicidal ideation.

MeSH terms

  • Acne Vulgaris* / chemically induced
  • Acne Vulgaris* / drug therapy
  • Acne Vulgaris* / epidemiology
  • Anti-Bacterial Agents / therapeutic use
  • Depression / psychology
  • Depressive Disorder, Major* / drug therapy
  • Depressive Disorder, Major* / epidemiology
  • Dermatologic Agents* / adverse effects
  • Humans
  • Isotretinoin / adverse effects
  • Retrospective Studies

Substances

  • Isotretinoin
  • Anti-Bacterial Agents
  • Dermatologic Agents