Acne is a common skin disorder that can cause a lot of distress, especially for teenagers. Severe acne can be difficult to treat.
Luckily, there are beneficial treatments available. The most powerful medication for severe acne is isotretinoin (Accutane is a common brand name). This medication can also be used to treat rosacea and other inflammatory skin disorders.
However, it is limited by a very high risk of severe birth defects and, possibly, psychiatric disorders including depression and suicidal thoughts and actions.
I say “possibly” because early indications showed that these psychiatric disorders were more frequent in people who used isotretinoin, although studies were not consistent in their findings.
Nevertheless, the FDA required a black box warning that isotretinoin may be associated with psychosis, aggression, depression and suicidality. Physicians were only allowed to prescribe it if they received special training about these side effects and the clear risk of severe birth defects.
Given the uncertainty about the possible risk of psychiatric illness as a side effect of isotretinoin, Tan and colleagues did a comprehensive analysis of research on this topic.
They published their findings in JAMA Dermatology Jan 2024; 160(1): 54-62. They analyzed “25 studies including 1,625,891 participants …”.
They found that the “risk of completed suicide, suicide attempt, suicidal ideation, and self-harm among isotretinoin users was less than 0.5% each, whilst that of depression was 3.83%” over one year.
They also found that the medication was “not associated with the relative risk of all psychiatric disorders, and isotretinoin users were less likely than nonusers to attempt suicide at 2 to 4 years following treatment.”
This finding is consistent with findings by Huang and colleagues who reported their conclusions in the Journal of the American Academy of Dermatology in 2018.
They stated that they found no association between isotretinoin and depression, and they indicated that “… the treatment of acne appears to ameliorate depressive symptoms.”
Tan and colleagues found that “… there is no epidemiological evidence to suggest an increased relative risk of suicide or psychiatric conditions among isotretinoin users at a population level.”
However, the authors did recommend that “clinicians should … monitor patients for signs of mental distress during isotretinoin treatment.”
Peter M. Hartmann, MD
Family Medicine & Psychiatry
