Suicide attempts in people taking isotretinoin for acne

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

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 …