The Risks and
Side Effects of Prescription Acne Medications
Vassilis P Kontaxakis, Demetris Skourides, Panayotis Ferentinos, Beata J Havaki-Kontaxaki, and George N Papadimitriou
Isotretinoin and psychopathology: a review
Ann Gen Psychiatry. 2009; 8: 2. Published online 2009 January 20. doi: 10.1186/1744-859X-8-2. PMCID: PMC2637283
The purpose of this study was to review available evidence regarding the association of isotretinoin and psychopathology. Isotretinoin, a synthetic oral retinoid that is used in the treatment of moderate to severe acne, has been associated with various psychiatric side effects such as depression, suicide and psychotic symptoms. A great number of reports on its effects have been published since its introduction into the market. Isotretinoin is the only non-psychotropic drug in the FDA's top 10 list of drugs associated with depression. However, a causal relationship has not been established and the link between isotretinoin use and psychiatric events remains controversial.
MEDLINE and EMBASE databases were searched for medical literature published from 1982 until March 2008 reporting psychiatric side effects following isotretinoin treatment. The study examined case reports, case series, reports from adverse drug event reporting systems, prospective surveys and retrospective case-control studies. The reference sections of the identified papers and main reviews were also screened. Additionally, several science papers which provided evidence for potential implication of the retinoids in the development of major psychiatric disorders were reviewed.
Most of the case reports describe the onset of psychiatric side effects within one month of the beginning of treatment with isotretinoin. However, depression has been reported as early as 1 day and up to 4 months after initiating isotretinoin treatment.
There is biological evidence that retinoids in general can influence the central nervous system (CNS) and in particular neuronal development, neurotransmitters and systems known to be involved in the pathogenesis of psychiatric disorders. Recent research has linked retinoids to schizophrenia. Some of the same biological mechanisms may be contributing to the development of depression.
The researchers concluded that the evidence strongly suggests a link between the use of isotretinoin and psychopathology. The major reasons for the lack of an established causal link between isotretinoin use and psychiatric symptoms is the absence of double-blind, placebo-controlled studies, some flaws in the methodology of the current research and some contradicting results in the studies of animal models. The reported psychiatric adverse events are likely associated with the isotretinoin's effects on various neurotransmitter systems and with the vulnerability of the exposed individuals. They recommend that physicians should be on the alert for potential psychiatric side effects following treatment with isotretinoin, especially in vulnerable populations.
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