Use of isotretinoin and risk of depression in patients with acne: a systematic review and meta-analysis

Abstract

ObjectiveThis study aimed to investigate the association between the use of isotretinoin and the risk of depression in patients with acne.DesignThis was a meta-analysis in which the standardised mean difference (SMD) and the relative risk (RR) were used for data synthesis employing the random-effects model.SettingStudies were identified via electronic searches of PubMed, Embase and the Cochrane Library from inception up to 28 December 2017.ParticipantsPatients with acne.InterventionsStudies comparing isotretinoin with other interventions in patients with acne were included.ResultsTwenty studies were selected. The analysis of 17 studies showed a significant association of the use of isotretinoin with improved symptoms compared with the baseline before treatment (SMD = −0.33, 95% CI −0.51 to −0.15, p<0.05; I 2=76.6%, p<0.05)). Four studies were related to the analysis of the risk of depression. The pooled data indicated no association of the use of isotretinoin with the risk of depressive disorders (RR=1.15, 95% CI 0.60 to 2.21, p=0.14). The association of the use of isotretinoin with the risk of depressive disorders was statistically significant on pooling retrospective studies (RR=1.39, 95% CI 1.05 to 1.84, p=0.02), but this association was not evident on pooling prospective studies (RR=0.85, 95% CI 0.60 to 2.21, p=0.86).ConclusionsThis study suggested an association of the use of isotretinoin in patients with acne with significantly improved depression symptoms. Future randomised controlled trials are needed to verify the present findings.

<p>Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience</p>

“…Treatment of acne with oral isotretinoin does not appear to be associated with increased depression for the majority of patients; in fact, it appears to be associated with a reduction in depressive symptoms. 11 There will be a small subset of patients who have increased depression and suicidal thoughts while on this medication. With this in mind, and given the increased predisposition -independently of other factors -to depression during adolescence, it would be prudent to recommend close monitoring of all patients with acne, to identify those who, due to individual susceptibility, have a high risk of depression.…”

“…7,8 Early reported side effects of oral isotretinoin 9,10 appeared alarming and probably influenced prescribing habits. Despite more recent studies and reviews showing a good safety profile, 11 there may be some persistent reluctance to prescribe the drug. Yet a delay in adequate treatment of acne can lead to physical scarring and affect quality of lifea balance must be struck to avoid undertreatment of this highly prevalent condition.…”

Depression, isotretinoin, and folic acid: A practical review

“…Although some psychiatrists are concerned about depressive effects of ISO use, Metekoglu, Oral, Ucar, and Akalin () reported no causal relation between ISO use and depression in acne patients. However, in a recent systematic review and meta‐analysis by Li et al (), the association of the use of ISO with the risk of depressive disorders was statistically significant on pooling retrospective studies, but this association was not evident on pooling prospective studies. It is of note that psychiatric side effects in patients taking ISO were investigated without exclusion of psychiatric comorbidities associated with acne.…”

Prevalence of depression among hypothyroid patients attending the primary healthcare and endocrine clinics of King Fahad Hospital of the University (KFHU)

“…[16] Some medications have shown to increase the risk of developing depression such as β-blockers, corticosteroids, and isotretinoin, yet the nature of those effects is yet to be understood. [171819] Around 10% of patients on corticosteroids will experience severe psychiatric adverse effects, ranging from depression to psychosis and delirium. [17] Isotretinoin has shown to increase the risk of developing depression among patients.…”

“…[17] Isotretinoin has shown to increase the risk of developing depression among patients. [18] B-blocker medications that are able to cross blood–brain barrier increase the risk of developing neuropsychological symptoms, such as drowsiness, fatigue, and lethargy. [19]…”