Isotretinoin (
13-cis retinoic acid) is an effective treatment for severe cystic or recalcitrant
acne vulgaris; however, concerns have been raised regarding its potential association with depression and suicidal behavior. We sought to explore the proposed relationship between
isotretinoin use and the risk of depression and attempted and completed suicide in patients with
acne vulgaris by performing a systematic literature search for studies reporting primary data on depression and suicidal behavior in patients treated with
isotretinoin for
acne vulgaris. Nine studies met the qualifying criteria for our analysis. Rates of depression among
isotretinoin users ranged from 1% to 11% across studies, with similar rates in oral
antibiotic control groups. Overall, studies comparing depression before and
after treatment did not show a statistically significant increase in depression diagnoses or depressive symptoms. Some, in fact, demonstrated a trend toward fewer or less severe depressive symptoms after
isotretinoin therapy. This decrease was particularly evident in patients with pretreatment scores in the moderate or clinical depression range. No correlation between
isotretinoin use and suicidal behavior was reported, although only one retrospective study presented data on this topic. Although the current literature does not support a causative association between
isotretinoin use and depression, there are important limitations to many of the studies. The available data on suicidal behavior during
isotretinoin treatment are insufficient to establish a meaningful causative association.