Isotretinoin (Accutane) and Depression

Do Isotretinoin Acne Medications Cause Depression?

Depressed woman
Photo: Sami Sarkis / Getty Images

So your dermatologist recommended you start taking isotretinoin (AKA Accutane) for your acne.  But you're nervous because you've heard that isotretinoin medications can cause depression and suicidal thoughts.

It's understandable to be a bit unnerved by the idea, and it's smart to do your research.  Only you can decide if the benefits of taking isotretinoin outweigh the potential side effects.  

Does Isotretinoin Cause Depression?

For a small number of people, it seems isotretinoin can trigger depression.

  But it's important to remember that not everyone taking isotretinoin will become depressed.

All in all, depression among those taking isotretinoin is fairly rare.  Depending on which study you look at, depression happens in anywhere from 1% to 11% of those taking the medication.  This doesn't necessarily mean the isotretinoin was causing the depression, though.

Depression occurred in some people with no prior history of the disorder. Other patients had factors, such as substance abuse, a family history, or stressful events in their lives, which may have contributed to their depression.

For those with bipolar disorder, there also seems to be an exacerbation of depression while taking isotretinoin.

Most people who became 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 in some cases, even after they quit using isotretinoin.

Finding the Link

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.

While countless case reports suggest a relationship between isotretinoin use and depression, proving this connection has been difficult.

Some studies suggest acne itself is more likely to cause depression in sufferers than isotretinoin use does. Still others have found no definitive link between isotretinoin and an increased risk of depression.

Benefits of Isotretinoin

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.

Having severe acne can be depressing in itself, and some studies have found that those with it are more likely to be depressed and are at higher risk of suicide.  Getting severe acne under control not only reduces your chance of developing scarring, but can also improve your self-image and self-confidence. 

What You Can Do

Reports of depression and suicidal behavior linked to isotretinoin use can be scary, but it's important to understand that these side effects are rare.

The most important thing you can do is have a frank talk with your dermatologist.  Make sure you completely understand your treatment plan, and get all of your questions answered.  Don't be afraid to ask lots of questions!

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

If you have any concerns whatsoever, notify your doctor immediately. It's important to be vigilant, but remember that most people can use isotretinoin medication without ever experiencing any psychiatric problems.

Next Steps:

3 Warning Signs You Should Never Ignore

Isotretinoin Alternatives for Treating Severe Acne


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Prevost N, English JC.  "Isotretinoin: update on controversial issues."  J Pediatr Adolesc Gynecol.  2013 Oct; 26(5):290-3.

On SC, Zeichner J.  "Isotretinoin updates."  Dermatol Ther. 2013 Sep-Oct; 26(5):377-89.

Borovaya A, Olisova O, Ruzicka T, Sardy M.  "Does isotretinoin therapy of acne cure or cause depression?"  Int J Dermatol.  2013 Sep; 52(9):1040-52.

Wolverton SE, Harper JC.  "Important controversies associated with isotretinoin therapy for acne."  Am J Clin Dermatol.  2013 Apr; 14(2):71-6.

Marron SE, Tomas-aragones L, Boira S.  "Anxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoin."  Acta Derm Venereol.  2013 Nov; 93(6)

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