A meta-analysis of 31 studies examining the relationship between isotretinoin treatment for acne and depression found no significant association. Rather, the treatment of acne was associated with improved symptoms of depression.
Researchers have been evaluating isotretinoin’s possible association with depression since 1983. Many studies have failed to find an association or have been inconclusive. One study found a statistically significant association between isotretinoin treatment and depression, but there are also depression risks associated with not treating a patient with severe acne.
Gathering the existing literature into a meta-analysis allowed the researchers to assess possible confounding factors in the individual studies, such as sex, length of treatment, and cumulative isotretinoin dose.
“In our meta-analysis, we pooled the results of 1,411 patients who received depression evaluations at baseline and after treatment, which revealed a significant improvement in the depression scores,” wrote Yu-Chen Huang, MD, of the department of dermatology, Taipei Medical University, Taiwan, and Ying-Chih Cheng, MD, of National Taiwan University. The 31 studies included 3 population-based studies, 8 controlled studies, and 20 prospective, open-label studies, and were published through September 2016.
Prevalence of depression also significantly dropped after treatment (relative risk, .588), they wrote, but they pointed out that “some studies described newly developed depression during treatment.” They referred to one controlled study in which “new onset of depression was noted in both the isotretinoin and antibiotic groups, implying that depression is associated with acne, independently of isotretinoin” (World J Psychiatr. 2016 Mar 22;6[1]:136-42). “Thus, physicians should consider the possibility of depression among all acne patients regardless of the treatment method,” they added.
They also concluded that some patients “might be more prone to depression regardless of acne or other conditions. Thus, closely monitoring acne patients for depression is essential to identify patients at a high risk.”
The full study can be found at: J Am Acad Dermatol. 2017 Jun;76[6]:1068-76.