depression, anxiety, and psychotic symptoms have been reported in patients treated with isotretinoin, and there have been cases where patients on isotretinoin died by suicide (1)
prescribers should discuss the risks of psychiatric disorders with patients and their caregivers fully before starting isotretinoin treatment
should include a discussion on the importance of seeking medical attention if their mental health is affected
recommended that patients taking isotretinoin ask their family and friends to watch out for potential symptoms of psychiatric disorders
neuropsychiatric reactions have been reported in patients taking oral retinoids (2)
healthcare professionals are advised to monitor patients for signs of depression or suicidal ideation and refer for appropriate treatment, if necessary; particular care is needed in those with a history of depression. Patients should be advised to speak to their doctor if they experience any changes in mood or behaviour, and encouraged to ask family and friends to look out for any change in mood
all patients taking isotretinoin should have an assessment of their mental health before starting treatment and be monitored regularly for signs of psychiatric symptoms by their prescriber and referred for appropriate treatment if necessary
discontinuation of isotretinoin may not be effective in alleviating symptoms and therefore further psychiatric or psychological evaluation may be necessary
Advice for healthcare professionals (1):
isotretinoin is indicated for severe forms of acne (such as nodular or conglobate acne or acne at risk of permanent scarring) resistant to adequate courses of standard therapy with systemic anti-bacterials and topical therapy
fully inform patients about the potential risks in addition to the expected benefits before prescribing isotretinoin
assess an individual’s mental health before initiation of isotretinoin and monitor regularly for developing or worsening psychiatric disorders
tell patients to seek advice if they feel their mental health or sexual function is affected or is worsening – patients with a serious side effect should be told to stop their treatment and seek urgent medical advice
report suspected adverse drug reactions associated with isotretinoin on a Yellow Card
Reference:
Drug Safety Update volume 16, issue 9: April 2023: 1.
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