isotretinoin and Depressive-Disorder

This study aimed to investigate the association between the use of isotretinoin and the risk of depression in patients with acne.. This was a meta-analysis in which the standardised mean difference (SMD) and the relative risk (RR) were used for data synthesis employing the random-effects model.. Studies were identified via electronic searches of PubMed, Embase and the Cochrane Library from inception up to 28 December 2017.. Patients with acne.. Studies comparing isotretinoin with other interventions in patients with acne were included.. This study suggested an association of the use of isotretinoin in patients with acne with significantly improved depression symptoms. Future randomised controlled trials are needed to verify the present findings.

Topics: Acne Vulgaris; Depressive Disorder; Dermatologic Agents; Humans; Isotretinoin; Prospective Studies; Retrospective Studies; Risk Assessment

The psychological consequences of acne have been the subject of many studies. As a particularly visible skin disorder, acne complicates the daily lives of adolescents who are undergoing multiple transformations: physical, intellectual and emotional. While it is well established that acne can be responsible for depression and low self-esteem, it is likely that this impact is aggravated by the sociological evolution of adolescents in the 21st century. Understanding the codes of adolescents today (who can be characterized as being more concerned by their appearance than previous generations at the same age) allows us to optimize our medical approach to acne and facilitates treatment compliance and adherence.

Topics: Acne Vulgaris; Adolescent; Adult; Anxiety Disorders; Attitude to Health; Depressive Disorder; Dermatologic Agents; Emotions; Female; Humans; Isotretinoin; Male; Mental Health; Mood Disorders; Physician-Patient Relations; Psychiatric Status Rating Scales; Surveys and Questionnaires; Young Adult

Isotretinoin is a remarkably effective drug for severe, recalcitrant acne vulgaris. Soon after the drug's release in the early 1980s, a number of important adverse effects were reported subsequently leading to a variety of medical and medicolegal controversies. Three of these controversies will be highlighted concerning the putative role of isotretinoin in (1) depression and suicide, (2) inflammatory bowel disease, and (3) iPledge and pregnancy prevention programs. It appears that a very small subset of patients receiving isotretinoin for acne are at risk for depression, which is very manageable provided there is adequate patient awareness of the possibility, maximum communication between the patient and physician, and cessation of therapy if clinically important depression occurs (after which the depression rapidly resolves in a week or less). Multiple controlled studies actually suggest a very favorable effect of isotretinoin on depression and anxiety common in the population requiring isotretinoin. With regard to inflammatory bowel disease, in just one study, only ulcerative colitis association with isotretinoin reached statistical significance. The actual incidence of this association is strikingly low. Finally, it is clear that even the most recent pregnancy prevention program (iPledge) is no more successful than prior programs; there will likely always be a small number of female patients becoming pregnant while receiving isotretinoin for acne vulgaris.

Topics: Acne Vulgaris; Depressive Disorder; Female; Follow-Up Studies; Humans; Incidence; Inflammatory Bowel Diseases; Isotretinoin; Male; Pregnancy; Risk Assessment; Severity of Illness Index; Suicide; Treatment Outcome

Cosmetic defects in acne may provoke a wide range of mental disorders (depressive, social-phobic, etc.). Isotretinoin is a very effective acne treatment; hence, it usually resolves the associated mental disorders. However, more available data show the possible association of taking isotretinoin and the onset of a depressive syndrome that includes frank depression and even suicidal ideation. The frequency of depressive disorders during isotretinoin treatment varies from 1% to 11% in different studies, and it is unclear whether this is a consequence of isotretinoin therapy. Since it crosses the blood-brain barrier, isotretinoin affects the expression of a broad spectrum of genes in the limbic structures, thus affecting the function of the dopaminergic, serotonergic, and noradrenergic neurons involved in the regulation of mood and emotion. It was suggested that isotretinoin in high concentrations inhibits hippocampal neurogenesis and induces apoptosis of hippocampal cells. However, some studies do not confirm this pathogenic role, and isotretinoin was even reported to have a therapeutic effect in acne-associated depression. In this review, we highlight epidemiological data, the underlying molecular pathogenesis, and the aspects of prevention concerning retinoid-induced depression in acne from the practical point of view of a dermatologist.

Topics: Acne Vulgaris; Animals; Depressive Disorder; Dermatologic Agents; Humans; Isotretinoin

There is currently considerable controversy regarding a proposed causal relationship between the use of isotretinoin and depression and suicide. A search was made of the MEDLINE, EMBASE and PsychINFO databases using the search terms 'isotretinoin', 'depression' and 'suicide'. Despite numerous case reports linking isotretinoin to depression, suicidal ideation and suicide, there is, as yet, no clear proof of an association. While isotretinoin, used to treat acne vulgaris, has not been demonstrated to be associated with depression or suicide, the possibility of a relatively rare idiosyncratic adverse effect remains. GPs have a role in the clinical application of these findings.

Topics: Acne Vulgaris; Depressive Disorder; Dermatologic Agents; Humans; Isotretinoin; Suicide

Acne is a common disorder that may have a considerable psychologic impact including anxiety and depression. Depression and suicide occur frequently in adolescents and young adults. Although case reports suggest an association between isotretinoin and depression and suicide, more rigorous observational studies and epidemiologic studies, using different designs, have not shown any effect of isotretinoin use in increasing the occurrence of depression and suicide. It is prudent for the practitioner to continue to use isotretinoin to treat severe acne, while at the same time informing patients and their relatives that depressive symptoms should be actively assessed at each visit and, if necessary, referral to a psychiatrist and a discontinuation of isotretinoin should be considered.

Topics: Acne Vulgaris; Adolescent; Adult; Australia; Depressive Disorder; Dermatologic Agents; Europe; Female; Humans; Isotretinoin; Male; Suicide; United States

Topics: Acne Vulgaris; Depressive Disorder; Female; Humans; Isotretinoin; United States; United States Food and Drug Administration

This paper examines the existing literature and MedWatch reports concerning a proposed relationship between isotretinoin and depression and suicide. The authors provide a brief overview of the biology of isotretinoin and depressive disorder and find no basis for a putative molecular mechanism linking the two. They also address the complexities of Substance-Induced Mood Disorder (SIMD) as a psychiatric diagnosis and its relevance to isotretinoin. Based on this review, the authors conclude that there is no evidence to support a causal connection between isotretinoin and major depression or suicide, because reported cases do not meet the established criteria for causality. The authors also conclude, however, that it is important for dermatologists to be aware of the risk factors for suicide and to monitor patients who exhibit depressive symptoms.

Topics: Acne Vulgaris; Depressive Disorder; Dermatologic Agents; Humans; Isotretinoin; Risk Factors; Suicide

Depression and mood changes appear as potentional side effects of isotretinoin in the Summary of Product Characteristics. There have been many studies treating this topic but in most cases not identifying any significant depression or suicide risk. To further investigate this issue, we conducted a prospective, uncontrolled study to evaluate mood changes and suicidal ideations in patients receiving isotretinoin therapy.. One-hundred patients were included in our single center, no-blind, and no controlled prospective study. All patients completed the Beck's Depression Inventory, Version II (BDI-II) before the treatment, following the first month of the treatment and then every third month until finishing the isotretinoin therapy. All questionnaires were checked by a psychiatrist. Suicidal ideations were monitored. Statistical analysis of BDI-II scores was performed.. All patients completed the study. Before the treatment, six percent of the patients had suffered from depressive symptoms. During the isotretinoin treatment, we did not find any deterioration of depression problems in any of these patients. On the contrary, in most patients the depressive symptoms disappeared. Symptoms of depression occurred in two patients, in which case coexisting situational factors were found to be the cause. No occurrence of suicidal ideations was found.. We did not find any depressive symptoms or suicide risk caused by isotretinoin. On the contrary, a statistically significant improvement of BDI-II scores was found. In our opinion, patients have to be informed about the risk of depression but emphasizing the fact that it is very rare.

Topics: Acne Vulgaris; Adolescent; Adult; Affective Symptoms; Child; Depressive Disorder; Dermatologic Agents; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Mood Disorders; Prospective Studies; Psychological Tests; Risk Factors; Suicidal Ideation; Surveys and Questionnaires; Young Adult

There have been concerns about the association between isotretinoin therapy and depressive symptoms.. The objective of this study is to evaluate whether there is an association between isotretinoin therapy and the onset of depression.. A total of 50 patients with moderate to severe recalcitrant acne and 30 healthy volunteer people were enrolled in the study. Depressive symptoms and anxiety status were assessed at baseline and then 1 and 4 months after the initiation of isotretinoin treatment.. We detected improvement in Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI) scores in acne patients after isotretinoin therapy. Statistically significant improvement in depressive symptoms began at the first month. Improvement in anxiety was detected later than the improvement in depressive symptoms and a statistically significant difference was detected between the first and the second follow-up.. Our results provide no relationship between isotretinoin use and depression in acne patients.

Topics: Acne Vulgaris; Adolescent; Adult; Depressive Disorder; Dermatologic Agents; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Psychological Tests; Young Adult

Isotretinoin therapy and its alleged adverse psychiatric effects have received considerable media attention during the past years. The aim of this pilot study was to investigate whether there was any association between isotretinoin therapy and anxiety, depression or suicidal ideation.. Forty-five patients with severe recalcitrant acne were enrolled in this study. Isotretinoin was administered at a dose of 0.5-1 mg/kg per day in two divided doses with food for 16 weeks. All patients received a complete dermatological examination and the severity levels of their acne were scored according to the Leeds Revised Acne Grading system at baseline (before isotretinoin treatment) and follow-up assessments at weeks 4, 8 and 16 of the treatment. Severity of anxiety and depressive symptoms were assessed with the Clinical Anxiety Scale and Montgomery-Asberg Depression Rating Scale before and upon completion of the 16-week isotretinoin treatment.. Twenty-three patients completed the final assessment. There was a statistically significant decrease in anxiety scores. Depression scores also decreased but were not statistically significant. No patient committed or attempted suicide.. This pilot study was unable to detect an association between the use of isotretinoin and an increased risk for anxiety, depression, or suicidal thoughts.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Alanine Transaminase; Anxiety; Aspartate Aminotransferases; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Depressive Disorder; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Manifest Anxiety Scale; Pilot Projects; Severity of Illness Index; Triglycerides

During isotretinoin treatment, special attention is required to detect any symptom or change in the mental health of patients. The monitoring is complex for adolescents because of confounding factors such as mood changes associated with adolescence and puberty and the higher psychosocial impairment due to the acne itself.. To determine the utility of the Adolescent Depression Rating Scale (ADRS) for monitoring symptoms in adolescents before and during isotretinoin treatment in dermatology real-life practice.. This was a national, multicentre prospective study that enrolled a random sample of dermatologists treating adolescents. An algorithm including ADRS score and its changes between consecutive visits was used. At each visit, dermatologists rated their satisfaction with ADRS and its ease of use, while patients rated the acceptability of the ADRS.. In total, 70 dermatologists used the algorithm for 1227 visits of 283 adolescents receiving isotretinoin. Of these 70 dermatologists, 80.8% were satisfied/very satisfied with the ADRS, 82.7% considered the use of the ADRS in clinical practice to be easy/very easy and 75% considered that the ADRS enabled them to discuss more easily the risk of depression with their patients. For the patients, acceptability of the ADRS was considered good by 93.8%.. The implementation of the ADRS could be valuable in dermatology practice, optimizing the monitoring of patients and the good use of isotretinoin.

Topics: Acne Vulgaris; Adolescent; Depression; Depressive Disorder; Dermatologic Agents; Dermatologists; Humans; Isotretinoin; Pilot Projects; Prospective Studies

Topics: Acne Vulgaris; Adolescent; Depressive Disorder; Dermatologic Agents; Humans; Isotretinoin; Male; Suicide, Attempted; Transgender Persons

SAPHO (synovitis, acne, pustolosis, hyperostosis and osteitis) syndrome is a rare autoinflammatory chronic disorder, presenting with non-infectious osteitis, sterile joint inflammation and skin manifestations including palmoplantar pustolosis and severe acne. It could be often misdiagnosed for its heterogeneous clinical presentation. Treatment is challenging and, due to the rarity of this syndrome, no randomized controlled clinical trials have been conducted. Empirical treatments, including non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antibiotics and bisphosphonates and disease-modifying anti-rheumatic drugs (DMARDs) could be quite effective. Anti-tumor necrosis factor-alpha (anti-TNF-α) agents and interleukin-1 (IL-1) antagonists have shown promising results in refractory patients. Isotretinoin, commonly used for severe acne, has been rarely described as possible trigger of osteo-articular manifestations, in particular sacroiliitis.. The case of a boy, affected by acne fulminans and depression, who presented with sacroiliitis after a 10-week treatment with isotretinoin is presented. After SAPHO diagnosis, NSAIDs therapy was started but the onset of bilateral gluteal hidradenitis suppurativa required the switch to a TNF-α antagonist (Adalimumab) with the achievement of a good control of the disease. Despite specific therapy with sertraline, the patient continued to complains severe depression.. Our case reports a temporal association between the onset of osteo-articular symptoms and the introduction of isotretinoin, as previously described. However, this timeline is not sufficient to establish a causal role of this drug into the pathogenesis of sacroiliitis. At this regard, further studies are required. The occurrence of hidradenitis suppurativa during SAPHO course supported the introduction of TNF-α blockers with a favourable result, as reported in a few cases in literature. The association between SAPHO syndrome and depressive mood disorders is already reported. Our patient experienced severe depression whose trend seems to be independent from the course of the main disease. Currently, it is not clarified if depression could be considered reactive to the underling disease or if it forms an integral part of the autoinflammatory disorder.

Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Adalimumab; Adolescent; Anti-Inflammatory Agents; Depressive Disorder; Dermatologic Agents; Humans; Isotretinoin; Male

Clinicians often face complex decisions regarding off-target drug effects, both in diagnosis and treatment. A key component in the formulation of the correct diagnosis is the temporal relationship between drug introduction and adverse effect. The sentinel injury may target the gut and brain. The description of the complaint may vary among providers. Modeling Information visualization for clinicians in real time will require the integration of time-stamped data with organ-specific complaints.

Topics: Acne Vulgaris; Adolescent; Anti-Ulcer Agents; Brain; Depressive Disorder; Dermatologic Agents; Humans; Isotretinoin; Male; Marijuana Abuse; Omeprazole; Polypharmacy; Stomach

Depression, anxiety, and obsessive compulsive symptoms are known to be common among patients with acne vulgaris. In contrast to earlier reports, a number of recent studies suggested isotretinoin to be beneficial for depression and anxiety symptoms in acne patients. Moreover, its effects on obsessive compulsive symptomatology are still widely unknown.. To examine the effects of isotretinoin treatment on obsessive compulsive symptoms, depression, and anxiety in acne vulgaris patients.. The Hospital Anxiety and Depression Scale, Maudsley Obsessive Compulsive Questionnaire, and Sheehan Disability Scale were administered to 43 patients with acne vulgaris who accepted isotretinoin treatment and agreed to participate in the study. Severity of acne was evaluated with Global Acne Grading System. Thirty-three patients completed 6 months treatment with oral isotretinoin at 0.5-1.0 mg/kg daily doses. Measurements were repeated at the end of 6 months.. Depression, anxiety, and obsessive rumination symptoms were significantly improved after isotretinoin treatment. On the other hand, obsessive doubting of acne patients was worse at the end of the treatment. There was no significant change in disease related disability of patients.. Besides worsening of obsessive doubting, successful treatment with oral isotretinoin seems to be related with improvement in depression, anxiety, and obsessive rumination symptoms in acne vulgaris patients. These changes were not reflected in the disability level that acne patients have reported.

Topics: Acne Vulgaris; Adolescent; Adult; Anxiety Disorders; Depressive Disorder; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Obsessive-Compulsive Disorder; Quality of Life; Severity of Illness Index; Treatment Outcome; Young Adult

Topics: Adolescent; Adult; Depressive Disorder; Dermatologic Agents; Female; Genetic Predisposition to Disease; Hallucinations; Humans; Isotretinoin; Male; Mental Disorders; Young Adult

Topics: Acne Vulgaris; Case-Control Studies; Cohort Studies; Cross-Over Studies; Depressive Disorder; Dermatologic Agents; Drug Administration Schedule; Humans; Isotretinoin; Research Design; Risk; Risk Factors

The incidence of depression in acne patients using isotretinoin was assessed in 100 patients with moderate and nodulocystic acne. All patients received 0.75-1.00 mg/kg/day of isotretinoin for 20-28 weeks after acne was assessed. All patients' acne lesions were improved at the end of the treatment period. Psychological state was evaluated at baseline, at Month 3, and Month 6 by a psychiatrist using a Turkish version of the Hamilton Depression Rating Scale. Only one patient's score increased to the clinical level of depression at Month 3 of treatment and declined to subclinical levels at Month 6. Although Hamilton scores increased at Month 3 over baseline scores, except for one patient, others' scores remained below the subclinical level for depression. At the end of Month 6, the mean score decreased below that at Month 3. These changes in means might be related to the onset of clinical effect of isotretinoin.

Topics: Acne Vulgaris; Adult; Cross-Sectional Studies; Depressive Disorder; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Incidence; Isotretinoin; Keratolytic Agents; Male; Personality Inventory; Risk

Although there have been case reports suggesting a relationship between treatment with the acne medication isotretinoin and the development of depression and suicide, this topic remains controversial. In order for isotretinoin to cause depression, it must have an effect on the brain; however, the effects of isotretinoin on brain functioning in acne patients have not been established. The purpose of this study was to assess the effects of isotretinoin on brain functioning in acne patients.. Brain functioning in adults was measured with [(18)F]fluorodeoxyglucose positron emission tomography before and after 4 months of treatment with isotretinoin (N=13) or an antibiotic (N=15).. Isotretinoin but not antibiotic treatment was associated with decreased brain metabolism in the orbitofrontal cortex (-21% change versus 2% change for antibiotic), a brain area known to mediate symptoms of depression. There were no differences in the severity of depressive symptoms between the isotretinoin and antibiotic treatment groups before or after treatment.. This study suggests that isotretinoin treatment is associated with changes in brain functioning.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Brain; Depressive Disorder; Female; Fluorodeoxyglucose F18; Frontal Lobe; Glucose; Humans; Isotretinoin; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Psychiatric Status Rating Scales; Severity of Illness Index; Tissue Distribution

Topics: Acne Vulgaris; Administration, Oral; Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Monitoring, Physiologic; Prevalence; Risk Assessment; Severity of Illness Index

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.. The objective of this study was to investigate whether there is an association between isotretinoin use and onset of depression.. 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.. Adjusted ratios for all antidepressants and by class were not significantly greater than 1.0. Similar results were found for minocycline.. The results do not support an association between the use of isotretinoin and the onset of depression.

Topics: Acne Vulgaris; Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Age Distribution; Antidepressive Agents; Child; Cohort Studies; Confidence Intervals; Depressive Disorder; Dermatologic Agents; Drug Prescriptions; Drug Therapy; Drug Utilization; Female; Humans; Incidence; Isotretinoin; Male; Middle Aged; Minocycline; Probability; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution

Topics: Depressive Disorder; Humans; Isotretinoin; Psychoses, Substance-Induced; Risk Factors; Suicide; Suicide, Attempted

Although knowledge concerning the dermatological treatment of chronic acne has grown considerably in recent years, relatively few studies have assessed the impact of effective physical intervention upon the psychoemotional functioning of patients. Hypotheses regarding the psychological impact of acne were developed using concepts drawn from evolutionary psychology. A sample of 34 patients (19 men and 15 women) with chronic acne were assessed for psychological, emotional and dermatological symptomatology using a variety of self-report questionnaires over four time-points during 16 weeks treatment with isotretinoin. Thirty-four patients completed the first assessment, 21 the second, 20 the third and 15 the fourth and final assessment. At the first assessment, prior to isotretinoin treatment, 15 patients (44%) reported clinically significant levels of anxiety, while six patients (18%) reported clinically significant depression. Women with acne were significantly more embarrassed than their male counterparts about their skin disease. Treatment with isotretinoin produced significant improvements across a wide variety of psychological functions, although the emotional status of patients appeared to be more resistant to change. Acne appears to be a condition which has the potential to damage, perhaps even in the long term, the emotional functioning of some patients.

Topics: Acne Vulgaris; Adolescent; Adult; Anxiety Disorders; Chronic Disease; Depressive Disorder; Emotions; Female; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male; Mental Disorders; Psychiatric Status Rating Scales; Psychometrics

Topics: Depressive Disorder; Humans; Isotretinoin; Keratolytic Agents

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Adult; Depressive Disorder; Female; Humans; Hypervitaminosis A; Isotretinoin; Male; Patient Care Team

Topics: Acne Vulgaris; Acute Disease; Adolescent; Depressive Disorder; Humans; Isotretinoin; Male

Sixteen patients with minimal facial acne but with symptoms of dysmorphophobia related to their acne were treated with isotretinoin, 0.5 mg/kg/day, (n = 5); 1 mg/kg/day (n = 11) for 16 weeks. All 16 had previously received long-term antibiotic therapy with no 'perceived' improvement in their acne. Formal psychiatric assessment was not possible through lack of cooperation. Fourteen of 16 patients derived benefit from isotretinoin therapy in that all 14 were subsequently satisfied with the cosmetic results achieved. However, the incidence of relapse was greater than that for a control group, 14 requiring additional therapy in the form of antibiotics or further isotretinoin (seven patients) within 20 months of completing the original course. Patients with acne and dysmorphophobia represent an important group of patients who benefit from treatment with isotretinoin; if possible this should be in conjunction with psychotherapy.

Topics: Acne Vulgaris; Adult; Body Image; Depressive Disorder; Female; Humans; Isotretinoin; Male; Psychotherapy; Recurrence