Does Isotretinoin cause depression? A dermatologists' perception and feasibility study

Background: Isotretinoin is the most efficacious treatment for acne vulgaris. It has been controversially associated with depression, suicidal ideation and suicide (1). Current literature on this issue remains conflicted and lacks well designed blinded randomized controlled trials (2). Aim: To assess Australian Dermatologists' experiences and perceptions with acne vulgaris patients treated with Isotretinoin and the development of depression, suicidal ideation and suicide. To conduct a feasibility study for a triple blind randomized controlled trial investigating the effects of Isotretinoin on depression and quality of life. Methods: This project consisted of two complimentary original studies. A questionnaire was conducted at the 48th Australasian Dermatologists' Annual Scientific Meeting. The feasibility study randomized all acne vulgaris patients meeting inclusion criteria who were willing to participate to Isotretinoin or Doxycycline for two weeks. Questionnaires screening for depression and quality of life were completed at baseline and at two weeks. Results: The questionnaire surveyed 120 Dermatologists with 73 responses included. Many Dermatologists had observed acne vulgaris patients on Isotretinoin develop depressive symptoms (77%). Most (66%) believe Isotretinoin could cause depression. The feasibility study screened 200 acne vulgaris patients and found despite the superior efficacy of Isotretinoin, patients would accept randomization. Conclusion: Many Australian Dermatologists are seeing acne vulgaris patients treated with Isotretinoin develop depressive symptoms and believe Isotretinoin is the cause. There is a distinct difference between clinical opinion and that in the literature. The feasibility study demonstrates a triple blind randomized controlled trial investigating the effects of Isotretinoin on depression and quality of life is possible