A meta-analysis showed lower risk for attempted suicide and no excess risk for other psychiatric disorders in isotretinoin users.

Early anecdotal reports, some among people who were well known or that involved dramatic events, suggested an excess risk for suicide after initiating isotretinoin for severe acne vulgaris. This belief has persisted despite opposing evidence, with some studies showing lower risk for depression with isotretinoin use. In this meta-analysis, researchers identified 24 observational studies (with 1.6 million patients) that addressed risk for suicide-related outcomes and other psychiatric disorders with isotretinoin.

Risk for any suicide-related outcome (i.e. suicide attempt, suicidal ideation, completed suicide or self-harm) was not higher with isotretinoin during as long as 10 years of treatment; analyses at years two to four showed risk for suicide attempt was lower among isotretinoin users than in nonusers. Risk for depression, bipolar disorder or other psychiatric disorder was not higher among isotretinoin users than in nonusers.

Comment: About one-quarter of all physicians certified to prescribe isotretinoin (certification is required because of the drug’s teratogenic effects) are primary care physicians. These results should encourage clinicians who prescribe isotretinoin (or care collaboratively for patients who receive the medication from dermatologists) to evaluate mental health concerns without regard to isotretinoin use. Patients should be reassured by these results when making decisions about isotretinoin.

Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Tan NKW, et al. Risk of suicide and psychiatric disorders among isotretinoin users: a meta-analysis. JAMA Dermatol 2023 Nov 29; e-pub (https://doi.org/10.1001/jamadermatol.2023.4579).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Pediatrics and Adolescent Medicine, Psychiatry.