Depression and isotretinoin

• depression, anxiety, and psychotic symptoms have been reported in patients treated with isotretinoin, and there have been cases where patients on isotretinoin died by suicide (1)
  • prescribers should discuss the risks of psychiatric disorders with patients and their caregivers fully before starting isotretinoin treatment
    • should include a discussion on the importance of seeking medical attention if their mental health is affected
      
      
    • recommended that patients taking isotretinoin ask their family and friends to watch out for potential symptoms of psychiatric disorders
      • neuropsychiatric reactions have been reported in patients taking oral retinoids (2)
        • healthcare professionals are advised to monitor patients for signs of depression or suicidal ideation and refer for appropriate treatment, if necessary; particular care is needed in those with a history of depression. Patients should be advised to speak to their doctor if they experience any changes in mood or behaviour, and encouraged to ask family and friends to look out for any change in mood
          
          
    • all patients taking isotretinoin should have an assessment of their mental health before starting treatment and be monitored regularly for signs of psychiatric symptoms by their prescriber and referred for appropriate treatment if necessary
      
      
    • discontinuation of isotretinoin may not be effective in alleviating symptoms and therefore further psychiatric or psychological evaluation may be necessary

Advice for healthcare professionals (1):

• isotretinoin is indicated for severe forms of acne (such as nodular or conglobate acne or acne at risk of permanent scarring) resistant to adequate courses of standard therapy with systemic anti-bacterials and topical therapy
• continue to follow strict precautions on prescribing isotretinoin, including the conditions of the isotretinoin Pregnancy Prevention Programme
• fully inform patients about the potential risks in addition to the expected benefits before prescribing isotretinoin
• assess an individual’s mental health before initiation of isotretinoin and monitor regularly for developing or worsening psychiatric disorders
• tell patients to seek advice if they feel their mental health or sexual function is affected or is worsening – patients with a serious side effect should be told to stop their treatment and seek urgent medical advice
• report suspected adverse drug reactions associated with isotretinoin on a Yellow Card

Reference:

1. Drug Safety Update volume 16, issue 9: April 2023: 1.
2. British National Formulary. Isotretinoin (Accessed April 29th 2023)