This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (76)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Psychiatry  • Depression  • Suicide  • Drug Therapy  • Adverse Effects  • Alert me on articles by topic  Social Bookmarking   What's this?

Susan S. Jick, DSc; Hilal Maradit Kremers, MD, MSc; Catherine Vasilakis-Scaramozza, MPH

Arch Dermatol. 2000;136:1231-1236.

Background  It has been suggested that there is a causal association between isotretinoin therapy and the risk of depression, psychotic symptoms, suicide, and attempted suicide.

Objective  To further investigate the proposed association between isotretinoin therapy and the risk of depression, psychotic symptoms, suicide, and attempted suicide using a formal study design.

Design  Large population-based cohort studies.

Setting  The Canadian Saskatchewan Health Database and the United Kingdom General Practice Research Database.

Patients  Data were analyzed for 7195 isotretinoin users and 13,700 oral antibiotic users with acne from the Canadian Saskatchewan Health Database and for 340 isotretinoin users and 676 oral antibiotic users with acne from the United Kingdom General Practice Research Database. All subjects had computer-recorded histories of between 6 months and 5 years before, and at least 12 months after, their first isotretinoin or antibiotic prescription.

Outcome Measure  Prevalence rates of neurotic and psychotic disorders, suicide, and attempted suicide were compared between isotretinoin and antibiotic users and within isotretinoin users as their own comparison (pretreatment vs posttreatment). The results were expressed as relative risks, calculated using multiple logistic regression analyses.

Results  Relative risk estimates, comparing isotretinoin use and oral antibiotic use with nonexposure to either drug for newly diagnosed depression or psychosis, were approximately 1.0 regardless of the data source. Similarly, relative risk estimates were all around 1.0 when comparing before with after isotretinoin use. The relative risk estimate for suicide and attempted suicide was 0.9 (95% confidence interval, 0.3-2.4) when comparing current isotretinoin exposure with nonexposure.

Conclusion  This study provides no evidence that use of isotretinoin is associated with an increased risk for depression, suicide, or other psychiatric disorders.

From the Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, Mass (Dr Jick and Ms Vasilakis-Scaramozza); and Global Drug Safety, F. Hoffmann–La Roche Ltd, Basel, Switzerland (Dr Kremers).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Dermatology Reader's Choice: Continuing Medical Education
Arch Dermatol. 2000;136(10):1284-1285.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Does Isotretinoin Increase the Risk of Depression?
Bigby
Arch Dermatol 2008;144:1197-1199.
FULL TEXT  

Does Isotretinoin Increase the Risk of Depression?--Reply
Azoulay and Berard
Arch Dermatol 2008;144:1234-1235.
FULL TEXT  

Retinoid-Mediated Regulation of Mood: Possible Cellular Mechanisms
O'Reilly et al.
Exp. Biol. Med. 2008;233:251-258.
ABSTRACT | FULL TEXT  

Chronic Oral Treatment with 13-cis-Retinoic Acid (Isotretinoin) or all-trans-Retinoic Acid Does Not Alter Depression-Like Behaviors in Rats
Ferguson et al.
Toxicol Sci 2005;87:451-459.
ABSTRACT | FULL TEXT  

Managing Adolescent Acne: A Guide for Pediatricians
Krowchuk
Pediatr. Rev. 2005;26:250-261.
FULL TEXT  

Inflammation and Extracellular Matrix Degradation Mediated by Activated Transcription Factors Nuclear Factor-{kappa}B and Activator Protein-1 in Inflammatory Acne Lesions in Vivo
Kang et al.
Am. J. Pathol. 2005;166:1691-1699.
ABSTRACT | FULL TEXT  

Functional Brain Imaging Alterations in Acne Patients Treated With Isotretinoin
Bremner et al.
Am. J. Psychiatry 2005;162:983-991.
ABSTRACT | FULL TEXT  

Isotretinoin Therapy and Mood Changes in Adolescents With Moderate to Severe Acne: A Cohort Study
Chia et al.
Arch Dermatol 2005;141:557-560.
ABSTRACT | FULL TEXT  

Trends in Adherence to a Revised Risk Management Program Designed to Decrease or Eliminate Isotretinoin-Exposed Pregnancies: Evaluation of the Accutane SMART Program
Brinker et al.
Arch Dermatol 2005;141:563-569.
ABSTRACT | FULL TEXT  

Isotretinoin (13-cis-retinoic acid; Accutane)
JWatch Pediatrics 2004;2004:10-10.
FULL TEXT  

Lumps, Bumps, And Things That Go Itch In Your Office!
McLeod
The Journal of School Nursing 2004;20:245-246.
FULL TEXT  

13-cis-retinoic acid suppresses hippocampal cell division and hippocampal-dependent learning in mice
Crandall et al.
Proc. Natl. Acad. Sci. USA 2004;101:5111-5116.
ABSTRACT | FULL TEXT  

Acne, isotretinoin and depression
DTB 2003;41:76-78.
ABSTRACT | FULL TEXT  

Isotretinoin and Psychiatric Illness in Adolescents and Young Adults
Enders and Enders
The Annals of Pharmacotherapy 2003;37:1124-1127.
ABSTRACT | FULL TEXT  

The risk of venous thromboembolism in women prescribed cyproterone acetate in combination with ethinyl estradiol: a nested cohort analysis and case-control study
Seaman et al.
Hum Reprod 2003;18:522-526.
ABSTRACT | FULL TEXT  

Accutane (isotretinoin) and psychiatric adverse effects
Wooltorton
CMAJ 2003;168:66-66.
FULL TEXT  

Methodological Limitations of the Study "Isotretinoin Use and Risk of Depression, Psychotic Symptoms, Suicide, and Attempted Suicide"
Wysowski et al.
Arch Dermatol 2001;137:1102-1103.
FULL TEXT  

Isotretinoin (Accutane) and Depression: No Association
Krowchuk
AAP Grand Rounds 2001;5:1-2.
FULL TEXT  

Isotretinoin Is Not Associated with an Increased Risk for Depression or Suicide
JWatch Psychiatry 2000;2000:12-12.
FULL TEXT  

Isotretinoin Is Not Associated with an Increased Risk for Depression or Suicide
JWatch Women's Health 2000;2000:9-9.
FULL TEXT  

Isotretinoin Is Not Associated with an Increased Risk for Depression or Suicide
Journal Watch Dermatology 2000;2000:1-1.
FULL TEXT