Isotretinoin (Accutane) and 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.

What Is Isotretinoin?

First, let's learn a bit about this medication.

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 sold under many different names, like Absorica and Zenatane, and also 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.

Does Isotretinoin Cause Depression?

There is no absolute proven link between isotretinoin and depression. For every study that has found a higher risk of depression in isotretinoin users, there is another that found no such risk.

But for a small number of people, it seems isotretinoin may trigger depression.

All in all, depression in people taking isotretinoin is fairly uncommon.

  Depending on which study you look at, depression happens in anywhere from 1% to 11% of people taking the medication.

This doesn't necessarily mean the isotretinoin was causing the depression, though. Depression can happen to anyone, whether taking isotretinoin or not.

Those With a History of Depression Seem to Be More Susceptible

Some people seem to be more susceptible to isotretinoin-induced depression than most.

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

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

It's important to remember, though, that just because you're taking isotretinoin does not 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 in some cases, even after they quit using isotretinoin.

There Is No Proven Link, but There are a Few Theories

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.

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

Using Isotretinoin Has Its Benefits Too

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

As many of my clients have told me, acne was making them depressed. Isotretinoin helped them feel less depressed as they noticed their skin clearing.

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

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 watch for major changes in your behavior that might signal a problem.

If you have any concerns whatsoever, notify your doctor immediately.

It's important to be aware, but remember that the vast majority of people use isotretinoin without having any issues with depression.

Sources:

Borovaya A, Olisova O, Ruzicka T, Sardy M.  "Does Isotretinoin Therapy of Acne Cure or Cause Depression?"  International Journal of Dermatology. 2013 Sep; 52(9):1040-52.

Huang YC, Cheng YC. "Isotretinoin Treatment for Acne and Risk of Depression: A Systematic Review and Meta-analysis." Journal of the American Academy of Dermatology. 2016 Mar; pii: S0190-9622(16)31289-0.

Ludot M, Mouchabac S, Ferreri F.  "Inter-relationships between Isotretinoin Treatment and Psychiatric Disorders: Depression, Bipolar Disorder, Anxiety, Psychosis and Suicide Risks."  World Journal of Psychiatry.  2015 Jun 22; 5(2): 222-7.

Melnik BC. "Apoptosis May Explain the Pharmacological Mode of Action and Adverse Effects of Isotretinoin, Including Teratogenicity." Acta Dermato-Venereologica. 2017 Feb;97(2):173-181.

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

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