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Isotretinoin and risk factors for suicide attempt: a population-based comprehensive case series and nested
C Droitcourt1,2,3,4, F Poizeau1,3,4, S Kerbrat3,4
1Department of Dermatology, CHU Rennes, Rennes, France.
Background:
Although the causal role of isotretinoin in suicidal behaviour is controversial, suicide attempts (SA) do occur among patients taking isotretinoin.
Objectives:
To describe patient profiles and the management of isotretinoin among patients who committed or attempted suicide under treatment. To assess the risk factors for SA under isotretinoin.
Methods:
We performed a comprehensive case series of suicides and SAs under isotretinoin, and a case-control study, using Nationwide French Health Insurance database. The main analysis compared cases (subjects with a SA during a course of isotretinoin) to controls, individually matched for age, gender and rank of the current course; controls were to be exposed to isotretinoin at the index date (date of SA for the corresponding cases). The patients' psychiatric history at isotretinoin initiation was studied. In a secondary analysis, patients who continued their isotretinoin treatment after their SA were compared to patients who discontinued it.
Results:
In all, 328 018 subjects started a course of isotretinoin between 1 January 2010 and 31 December 2014 and 184 patients were hospitalized for a SA; half of them had a psychiatric history at initiation. In the multivariate analysis, psychiatric history and history of anxiety alone were risk factors for SA [Odds ratio (OR), 18.21; 95% confidence interval (CI), 9.96-33.30 and 4.78; 95% CI, 2.44-9.33, respectively]. Among 176 cases of SA with sufficient follow-up, 103 (58.5%) carried on with their treatment after their SA. Treatment initiation by a dermatologist was inversely associated with the continuation of the treatment after a SA (OR, 0.38; 95% CI, 0.18-0.80).
Conclusions:
Suicide attempts under isotretinoin are rare events, and our results suggest that most of the patients concerned have a risk-prone profile detectable at the time of treatment initiation. The risk-benefit ratio of continuing isotretinoin after a SA warrants further careful evaluation.
Insights
Suicide attempts (SA) are rare in patients taking isotretinoin, but a history of psychiatric issues or anxiety significantly increases risk. Most patients continue isotretinoin after an SA, highlighting the need for careful risk-benefit evaluation.
Area of Science:
- Dermatology
- Psychiatry
- Public Health
Background:
- Isotretinoin is a widely used acne medication, but its association with suicidal behavior remains controversial.
- Suicide attempts (SA) have been reported in patients undergoing isotretinoin treatment.
Purpose of the Study:
- To characterize patients who attempted suicide while on isotretinoin.
- To identify risk factors for SA in patients treated with isotretinoin.
- To examine the management of isotretinoin in patients with SA.
Main Methods:
- A case series and case-control study were conducted using the Nationwide French Health Insurance database.
- Patients with SA during isotretinoin treatment were compared to matched controls exposed to isotretinoin.
- Psychiatric history at treatment initiation and continuation of isotretinoin after SA were analyzed.
Main Results:
- Out of 328,018 patients, 184 were hospitalized for SA; half had a prior psychiatric history.
- Multivariate analysis identified psychiatric history (OR 18.21) and anxiety (OR 4.78) as significant risk factors for SA.
- Over half of patients continued isotretinoin after SA, with dermatologist initiation inversely associated with continuation (OR 0.38).
Conclusions:
- Suicide attempts during isotretinoin treatment are infrequent.
- A significant proportion of patients experiencing SA have identifiable risk factors at treatment initiation.
- The decision to continue isotretinoin after a suicide attempt requires careful risk-benefit assessment.
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