RISK OF DEPRESSION AND SUICIDAL BEHAVIOUR IN ACNE PATIENTS TREATED WITH ISOTRETINOIN: A SYSTEMATIC REVIEW AND META-ANALYSIS
Main Article Content
Keywords
isotretinoin is also associated with the risks of depression and suicidal ideation, and acne as well. The finding is based on a meta-analysis.
Abstract
The most current systematic reviews and meta-analyses of fifteen observational studies (over 30 thousand people being involved) support the higher risk of depression and suicidal tendencies among adolescents receiving acne treatment with isotretinoin. The study finds that individuals receiving isotretinoin have 52% and 68% higher risks of depression and suicidal behavior, respectively, vs. the control group. Such observations, therefore, prove the legitimacy of the controversies of the past, regarding psychiatric side effects producing a boxed warning in spite of the mixed results of the early trials. The meta-analysis technique deals with inconsistencies and biases that are typical for small samples. Consistency was found across categories, sensitivity analyses and methods's quality. No chance finding could explain this relationship. By means of well-established statistical methods, the description of trend is as real as ever. Sound risk versus benefit judgment is paramount for the clinic to attain with this effective acne treatment. While isotretinoin that cures the most severe, drug-resistant acne better than other treatments, special attention must be paid to its psychiatric effects that require adequate screening and closer monitoring of patients with a subsequent advice that they should be referred to psychiatry. On-going studies should determine which groups are particularly susceptible to these risks and what measures could be taken to better formulate risk mitigation strategies. For the moment, such psychological adverse effects should be viewed in a critical way as a part of the isotretinoin evaluation process.
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Dr. K. Radha Raja Prabha
Associate Professor, Dermatology, SMMCH&RI
Dr. S. Karthik Raja
Associate Professor, Dermatology, SMMCH&RI
Dr. Misbah Dulvi
Senior Resident, Dermatology, SMMCH&RI
Dr. V.U. Karthikeyan
Associate Professor, Department of Psychiatry, SMMCH&RI