Isotretinoin (
Accutane) is a treatment for severe
acne that is resistant to other forms of treatment, including
antibiotics and topical treatments. The prescription of this
drug has been controversial ever since its initial marketing in 1982. It is the only non-
psychotropic drug in the Food and Drug Administration top 10 drugs found to be associated with depression. Recently, Bremner et al published an extensive review (until 2010) of the evidence for the association of
retinoic acid (RA) with depression and suicide. Some patients who are admitted in psychiatric hospitals report a history of present or past treatment with
isotretinoin. Then, the imputability of the molecule in the occurrence of disorders represents necessarily an important question for both professionals and their patients. This paper aims to specify the links between the
drug and specific
psychiatric disorders. A review of the literature related to
isotretinoin, RA,
vitamin A, depression, suicide, anxiety,
bipolar disorder,
psychosis,
schizophrenia was performed. Many studies demonstrated an increased risk of depression, attempted suicide and suicide following
isotretinoin treatment. However,
isotretinoin may have an
antidepressant impact, according to some dermatological papers. They consider treating
acne with this efficient treatment could improve self-image and make the patient feel better. Several studies showed that patients with
bipolar disorder had an increased risk for a clinical exacerbation of symptoms undergoing treatment with
isotretinoin. A few studies also seem to suggest a possible link between
isotretinoin and
psychosis. Nonetheless, studies point out a link between
retinoid dysregulation and
schizophrenia through modulation of
dopamine receptors. From this review, we propose guidelines for
isotretinoin prescription to healthcare professionals.