Patients with severe acne have a higher risk of depression and attempting suicide compared to individuals without the condition, even one year after isotretinoin treatment, researchers from the Karolinska Institute, Sweden, wrote in the BMJ (British Medical Journal). Isotretinoin, which may appear as brand names Decutan, Clarus, Claravis, Accutane, Roaccutane or Amnesteem has been a commonly prescribed severe acne medication for over twenty-five years. It is generally an effective medication.

Isotretinoin has been sometimes linked to suicidal behavior and depression. However, in this article the authors believe these characteristics are linked to the severe acne itself, and perhaps not the medication. They add that previous studies aimed at determining whether isotretinoin was linked to suicidal behaviors produced conflicting, and subsequently unclear results.

Dr. Anders Sundstrom and team set out to examine suicide rates around the time of isotretinoin treatment – before, during and after its administration. Before their study began, they hypothesized that suicide risk was linked to severe acne, regardless of whether they were taking the medication.

They gathered information on patients who had been prescribed isotretinoin by their doctors from 1980 through 1989, and correlated the data against hospital discharge information and cause of death registers from 1980 to 2001.

They examined data on 5,756 patients, 63% of whom were male. An average male with severe acne is usually prescribed isotretinoin at the age of 22, and females when they are 27.

The researchers identified 128 individuals from the list who had been hospitalized after trying to commit suicide. They also noticed that from one to three years before isotretinoin treatment began, the rate of suicide attempts among patients with severe acne rose, with a peak six months after treatment had been completed.

The investigators believe this six-month-post-treatment peak may be due to frustration and anxiety by the patient who saw no improvement in their social life, despite improved acne symptoms and better physical appearance.

Whether the continued increase in attempted suicide risk is due to the acne itself or a side effect of the treatment is impossible to say for certain, the authors stress.

The authors wrote:

    (the rise in suicide attempt risk might be) “As a consequence of exposure to the drug, but a more probable interpretation is that the underlying severe acne may best explain the raised risk.

Even so, the authors emphasize, the absolute suicide attempt risk is still low, about 1 in every 2,300 severe acne patients on the drug – and that is when one assumes that the whole risk increase is due just to isotretinoin.

The researchers concluded:

    “The most important proactive measure to be taken would be to closely monitor all patients’ psychiatric status, not only during treatment, but also for at least a year after treatment with isotretinoin.”

Not only should monitoring of patients receiving the medication be carried out diligently, but other severe acne patients who are not on the same treatment should too, the authors added.

Two Australian researchers, Parker Magin and John Sullivan, in an Accompanying Editorial wrote:

    “It is difficult to tease out the relation between mental health and isotretinoin because acne itself is associated with psychiatric morbidity, including depression.”

They stress the importance of monitoring severe acne patients for depression and suicidal thoughts, especially those whose symptoms do not respond well to treatment.

“Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study”
Anders Sundström, Lars Alfredsson, Gunilla Sjölin-Forsberg, Barbro Gerdén, dermatologist, Ulf Bergman, Jussi Jokinen
BMJ 2010; 341:c5812 doi: 10.1136/bmj.c5812 (Published 11 November 2010)

Written by Christian Nordqvist