Evaluating Depression Among Acne Vulgaris Patients Treated With Isotretinoin

Abstract

Background Isotretinoin is the most effective treatment for moderate to severe acne. However, isotretinoin has many side effects related to its use. Since 1983, when Hetzen reported the first occurrence of new depressive symptoms in patients treated with isotretinoin, a lot of controversies emerged regarding the causal relationship between isotretinoin and depression. Objective To evaluate depression among acne patients treated with isotretinoin versus doxycycline at King Fahad Hospital of the University between December 2019-March 2020. Methods Using the Global Acne Grading System, patients aged 18 - 30 years old with moderate to severe acne vulgaris who have not received isotretinoin previously and has no personal or family history of any psychiatric illnesses, were evaluated for depression using the patient health questionnaire-9 before starting treatment and 8 weeks after. Twenty-nine patients had met the inclusion criteria and were included in the study. Results Of the 29 patients included, 18 patients completed the study (nine males, nine females). Twelve patients received isotretinoin 0.5mg/kg (study group) and six patients received doxycycline 100mg (control group). The mean depression score for the isotretinoin group has decreased from (4 ± 2.48) to (3.08 ± 2.84) but the result was statistically insignificant with a p-value of 0.19, CI (-5.28, 2.36). For the doxycycline group, the mean depression score has decreased from (5.5 ± 2.5) to (2.83 ± 0.75) with a p-value of 0.043, CI (0.12, 5.21). There was no statistically significant difference in the mean depression score between the two groups after 8 weeks of starting treatment [p-valve 0.837, CI (-2.28, 2.78)]. Conclusion This study showed that, after 8 weeks of starting treatment, isotretinoin at 0.5 mg/kg has no risk of developing depression. The results of this study did not reveal a direct relationship between the use of isotretinoin and the development of depression. Furthermore, optimum control and treatment of acne vulgaris have shown to improve depression scores.

Isotretinoin treatment and risk of depression in acne vulgar patient: what is the evidence?

“…This evidence-based review demonstrated that treatment of acne patients with isotretinoin does not appear to be related to the development of depression, with a strength of recommendation of A 3,4,[6][7][8] . We further conclude that treatment of acne, regardless of chosen drug, seems to improve depressive symptoms 3,6,7 .…”

“…After a detailed analysis of the included studies, we found that there is no evidence that isotretinoin is associated with depression 3,4,[6][7][8] .…”

“…In Saudi Arabia, Algandi et al 8 performed a prospective questionnaire-based cohort study from November 2019 to March 2020 to assess the risk of depression in acne patients treated with isotretinoin, at a daily dose of 0.5 mg/kg, versus doxycycline in a daily dose of 100 mg (control group). The study included 29 patients with moderate to severe acne aged between 18 and 30.…”

Is Isotretinoin in Acne Patients a Psychological Boon or a Bane: A Systematic Review

“…The study conducted in Venezuela by Suarez et al implies that Isotretinoin is safe to use with respect to psychological side effects [ 15 ]. The cohort and nested case-time-control study in France by Droitcourt et al and the cohort prospective, questionnaire-based study conducted in Saudi Arabia by Algamdi et al suggest that is no association between Isotretinoin and depression [ 18 , 19 ]. The systematic review and meta-analysis by Huang et al in Taiwan also suggest the same [ 20 ].…”

“…A cohort prospective, questionnaire-based study was conducted in Saudi Arabia by Algamdi et al from November 2019 to March 2020 on 29 patients [ 19 ]. The subjects included in this study were moderate to severe acne patients aged 18-30 years.…”