Does isotretinoin cause depression and suicide?

Area of Science:

• Dermatology
• Psychiatry
• Pharmacology

Background:

• Isotretinoin is a widely used oral retinoid for severe cystic acne.
• A controversial association between isotretinoin and adverse psychiatric events, including depression and suicide, has been reported.

Purpose of the Study:

• To review the existing evidence regarding the relationship between isotretinoin use and the risk of depression and suicide.
• To inform clinical practice and guide future research in this area.

Main Methods:

• Systematic review of published case reports.
• Analysis of challenge-rechallenge studies.
• Examination of adverse event reports submitted to regulatory agencies.
• Review of proposed biological mechanisms.

Main Results:

• Evidence regarding the isotretinoin-depression/suicide link remains controversial.
• Multiple data sources, including case reports and regulatory data, suggest a possible association.
• Biological mechanisms for a potential link are under investigation.

Conclusions:

• Clinicians should counsel patients on the potential risks of depression and suicide associated with isotretinoin.
• Routine screening for depression using self-report questionnaires during isotretinoin treatment is recommended.
• Further epidemiological and neurobiological research is necessary to definitively assess the association.