isotretinoin and Psychotic-Disorders

It has been suggested that there is a causal association between isotretinoin therapy and the risk of depression, psychotic symptoms, suicide, and attempted suicide.. To further investigate the proposed association between isotretinoin therapy and the risk of depression, psychotic symptoms, suicide, and attempted suicide using a formal study design.. Large population-based cohort studies.. The Canadian Saskatchewan Health Database and the United Kingdom General Practice Research Database.. Data were analyzed for 7195 isotretinoin users and 13,700 oral antibiotic users with acne from the Canadian Saskatchewan Health Database and for 340 isotretinoin users and 676 oral antibiotic users with acne from the United Kingdom General Practice Research Database. All subjects had computer-recorded histories of between 6 months and 5 years before, and at least 12 months after, their first isotretinoin or antibiotic prescription.. Prevalence rates of neurotic and psychotic disorders, suicide, and attempted suicide were compared between isotretinoin and antibiotic users and within isotretinoin users as their own comparison (pretreatment vs posttreatment). The results were expressed as relative risks, calculated using multiple logistic regression analyses.. Relative risk estimates, comparing isotretinoin use and oral antibiotic use with nonexposure to either drug for newly diagnosed depression or psychosis, were approximately 1.0 regardless of the data source. Similarly, relative risk estimates were all around 1.0 when comparing before with after isotretinoin use. The relative risk estimate for suicide and attempted suicide was 0.9 (95% confidence interval, 0.3-2.4) when comparing current isotretinoin exposure with nonexposure.. This study provides no evidence that use of isotretinoin is associated with an increased risk for depression, suicide, or other psychiatric disorders.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Child; Cohort Studies; Depression; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Psychotic Disorders; Retrospective Studies; Risk Factors; Suicide; Suicide, Attempted; United Kingdom

Topics: Child; Humans; Isotretinoin; Neuroblastoma; Psychotic Disorders

Topics: Acne Vulgaris; Dermatologic Agents; Humans; Isotretinoin; Psychotic Disorders

Isotretinoin (Accutane) ranks in the top 10 of the US Food and Drug Administration's database of drugs associated with reports of depression and suicide attempts. However, this association is still controversial because up to 5.6% of patients with moderate acne may have pre-existing suicidal ideations, improvement of acne often reduces associated depression, and isotretinoin users are reportedly no more likely than those taking antibiotics for acne to have depression or commit suicide. We describe a series of cases of manic psychosis that developed in a 1-year period (2003) in association with isotretinoin treatment and resulted in suicidality and progression to long-standing psychosis. Cases were drawn from 500 soldiers who had been evaluated in a military specialists dermatology clinic for severe acne. Data were summarized from medical records of five severe acne patients treated by isotretinion during their compulsory military service. Data from their draft board examinations and service records, as well as repeated clinical assessments by certified psychiatrists at the Israel Defense Forces (IDF) Mental Health Department clinic, were evaluated. Five young adults developed manic psychosis within a mean of 7.6 months of exposure to isotretinoin. In three cases, this was accompanied by a suicide attempt, and in three cases, psychosis lasted for longer than 6 months. Either a personal history of obsessive-compulsive disorder, neurological insult or family history of a major psychiatric illness were present in all cases. The present case-series is suggestive of an increase in the likelihood of an association between exposure to isotretinion and manic psychosis. Associated risk factors were both family and personal history of psychiatric morbidity. Further studies are needed to establish our findings.

Topics: Acne Vulgaris; Adult; Disease Progression; Female; Humans; Isotretinoin; Israel; Male; Military Personnel; Psychotic Disorders; Risk Factors; Suicide, Attempted; Time Factors

Topics: Depression; Dermatologic Agents; Humans; Isotretinoin; Psychotic Disorders; Risk Factors; Suicide, Attempted

Topics: Adult; Darier Disease; Humans; Isotretinoin; Male; Military Personnel; Military Psychiatry; Psychotic Disorders; Risperidone