The Association Between Isotretinoin Use and Suicidality in Adolescents: A Narrative Review

Multiple meta-analyzes suggest that acne improvement with isotretinoin leads to improved mental health outcomes in adults, though isotretinoin-related psychiatric data, including for suicidality, are limited for adolescents.

PubMed, MEDLINE, EmBase, PsychINFO, and the Cochrane Library databases were searched for papers published between 1982 and September 2024 that reported suicidality following isotretinoin treatment for acne vulgaris in adolescents aged 18 or younger.

A total of 24 full text articles were reviewed. Despite numerous case reports describing suicidal ideation, suicide attempts, and completed suicides were rare. Databases suggest that adolescents taking isotretinoin are the group with the most suicide attempts, but epidemiological studies including matched controls suggest this could be a function of the number of prescriptions in this population. Observational, cohort, and case-time-control studies did not consistently report an increased risk of suicidality with isotretinoin. When compared with those prescribed antibiotics, isotretinoin-prescribed adolescents had no increase in suicidality during treatment but had a higher prevalence of suicidal behavior in the year after treatment. If patients prescribed isotretinoin developed suicidal ideation, it was more likely to develop early in or following completion of treatment.

There exists a conventionally held belief in the association between isotretinoin use and suicidal ideation for adolescent patients, but this narrative review does not indicate a consistent relationship.