Isotretinoin, vitamin A derivates and Psychopathology: Making the point

Isotretinoin (13-cis retinoic acid, a retinoid receptor agonist) is a synthetic oral retinoid that has great efficacy against severe cystic or recalcitrant acne vulgaris. The growing number of reported cases of depression and suicide associated with isotretinoin use in patients with acne has prompted concern among dermatologists, patients, and their relatives and has triggered new warnings from regulators including depression-related, patient-informed consent forms. Despite this increasing number of reports in medical journals the association between isotretinoin and depression has received little attention in the psychiatric literature. The purpose of this critical review is to highlight this association, examine the possible link and review the clinical implications. A search was made of the MEDLINE, EMBASE, COCHRANE and PsychINFO databases using the search terms 'isotretinoin', 'depression' and 'suicide'. At the present time there is no evidence that use of isotretinoin is associated with an increased risk for depression, suicide, or other psychiatric disorders. Although the current literature does not support a causative association between isotretinoin use and depression, there are important limitations to many of the studies: the available data are insufficient and , at the present time, there is no known pharmacological mechanism that would account for psychiatric symptomatology, however, retinoid receptors are widely distributed in the brain and more research is needed to ascertain whether they have a role in depression. © 2011 by Nova Science Publishers, Inc. All rights reserved.