Editorials

Suicide attempts in people taking isotretinoin for acne

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5866 (Published 12 November 2010) Cite this as: BMJ 2010;341:c5866
  1. Parker Magin, senior lecturer1,
  2. John Sullivan, senior lecturer2
  1. 1Discipline of General Practice, University of Newcastle, Callaghan, NSW, 2308, Australia
  2. 2Discipline of Dermatology and Clinical Pharmacology, University of New South Wales, Sydney, NSW, Australia
  1. parker.magin{at}newcastle.edu.au

Are increased, but the risk is difficult to separate from the higher risk associated with the condition itself

In the linked study (doi:10.1136/bmj.c5812), Sundström and colleagues assess the association between isotretinoin (13-cis-retinoic acid) taken by people with severe acne and attempted suicide.1 Isotretinoin is effective for severe nodulocystic or treatment resistant acne, but its use is controversial. Isotretinoin is associated with considerable mucocutaneous side effects, other adverse effects, and a high risk of teratogenicity, but it is the putative links with depression and suicide that have generated most unease in users, potential users, and their families.3

F Hoffman-La Roche Ltd, Basel

Concerns about an association with suicide and depression were initially prompted by case reports and case series.4 Although a causative association is biologically plausible,5 epidemiological studies have generally failed to find one. Analysis of data from the Canadian health database and the UK general practice database found no increase in depression, attempted suicide, or suicide in people with acne who used isotretinoin compared with those who used antibiotics and no changes in these outcomes before and after treatment with isotretinoin.6 …

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