Isotretinoin and Depression Risk

Dermatologists will sometimes recommend the prescription drug Accutane (isotretinoin) for people with hard-to-treat acne. However, when reading the prescribing leaflet, users will often become unnerved to find depression and suicidal thoughts listed among the safety warnings.

It's an understandable reaction and one that deserves full disclosure as to the benefits and risk of treatment.

Isotretinoin Background

Isotretinoin is an oral medication that is used to treat severe acne. It is sometimes used to treat acne that isn't necessarily severe, but stubborn and not clearing up with other acne medications.

Isotretinoin is was originally approved under the brand names Accutane and Roaccutane. Since then, it has been produced by other manufacturers under different names, like Absorica and Zenatane, and even as generic isotretinoin.

All of these medications have the same active ingredient and all work in the same way. All isotretinoin medications are prescription only, and you must register in the iPledge program before you may fill your prescription.

The iPledge program was created to advise consumers that isotretinoin is contraindicated in pregnancy due to the high risk of birth defects. Isotretinoin can only be prescribed to registered users who meet program qualifications.

Depression Risk

There is no clear, proven link between isotretinoin and depression. For every study that has found a high risk of depression in isotretinoin users, there is another that has found no risk. With that being said, it seems isotretinoin does pose a risk depression to a small number of users.

All in all, depression in people taking isotretinoin is fairly uncommon. Depending on which study you look at, depression happens in anywhere from 1 percent to 11 percent of people taking the medication. This doesn't necessarily mean the isotretinoin causes depression.

While isotretinoin-induced depression can affect people with no prior history of the disorder, a great many have had pre-existing conditions that place them at risk, including substance abuse, bipolar disorder, or a family history of depression.

It's important to remember that just because you're taking isotretinoin doesn't mean you will become depressed. Most people who did become depressed while using isotretinoin found that their symptoms went away once they stopped using the drug. But for some people, depression and suicidal behavior persisted even after they quit using the drug.

Theoretical Causes

While case reports suggest a relationship between isotretinoin use and depression, there is no proven link. Still, some research has presented a few theories.

Isotretinoin is derived from vitamin A. Vitamin A is responsible for many functions in the central nervous system. Researchers believe isotretinoin may disrupt the way serotonin is made and utilized by the body. Low levels of serotonin have been linked to depression, bipolar disorder, anxiety disorders, and aggression.

Another theory looks at how isotretinoin causes changes in the area of the brain called the hippocampus. The hippocampus creates neurons constantly, a process called neurogenesis. Neuron formation in the hippocampus is reduced while taking isotretinoin (at least in mice and rats). This decrease in neurogenesis may be a biological reason for depression while taking isotretinoin.

It's theorized that people in which neuron formation is already reduced in some way may be more susceptible to this decrease in neurogenesis caused by isotretinoin than others. That would explain why some people seem to develop depression while taking isotretinoin while others never do.

Having severe acne can also cause depression and even increase the risk of suicide.

A 2010 study published on BMJ Online found that, among than 5,700 isotretinoin users, the risk of suicide was highest among those who had stopped treatment for six months and lowest among those who were actively taking the drug.

What this suggests is that the return of severe acne (and the prospect of living with the condition for the rest of their lives) was at the heart of the 128 suicide attempts.

Other studies have found no definitive link between isotretinoin and an increased risk of depression.

Using the Drug Safely

Although isotretinoin comes with side effects, it is incredibly effective at clearing the most severe inflammatory or cystic acne, even cases that don't respond to other medications. It's important to weigh the benefits against the risks.

Getting severe acne under control not only reduces your chance of developing scarring but can also improve your self-image and self-confidence.

If you decide to go forward with isotretinoin treatment, there's no reason to be anxious. While you (or your child) is taking Accutane, watch for any symptoms of depression, like:

  • Changes in mood and behavior
  • Feeling unusually sad, angry, irritable, or aggressive
  • Trouble concentrating
  • Suicidal thoughts, or thoughts of hurting yourself
  • Seeing or hearing things that are not real

Sometimes those closest to you will see changes in your demeanor and personality before you notice them yourself. You may want to enlist their help, and let them know about your treatment so they can also help you be on the watch for major changes in your behavior that might signal a problem.

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Article Sources
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