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Suicidal behaviours not increased with use of isotretinoin

A retrospective study of an insurance database in the U.S. has revealed patients with acne who were prescribed isotretinoin were less likely to engage in suicidal behaviours compared to the general population. The study included 72,555 patients aged 12 to 35 years of age. Using records from the IBM MarketScan Research Databases, containing data on commercial insurance claims in the United States, the researchers identified acne patients who were prescribed isotretinoin or oral antibiotics between 2011 and 2017 and who were diagnosed with psychiatric disorders or suicidal behaviour.

“The association between isotretinoin and psychiatric disturbance, including depression and suicidal behaviour, is controversial,” Dr. Nkemjika Ugonabo, of the Ronald O. Perelman Department of Dermatology at the New York University Grossman School of Medicine, and colleagues wrote in the paper (Journal of the American Academy of Dermatology 2021 Oct; 85(4):878-884).

According to the results of the study, patients in the general population were 1.47 times more likely to be diagnosed with suicidal ideation or suicide attempt compared to acne patients prescribed isotretinoin (adjusted odds ratio [OR] 1.47; confidence interval [95% CI], 1.27, 1.70; p<0.0001). The researchers did note that the general population and acne patients prescribed antibiotics were less likely to have a psychiatric diagnosis compared to acne patients prescribed isotretinoin. The prevalence of suicidal behaviour during isotretinoin treatment was lower (0.10%; p=0.082) than in the year prior to isotretinoin treatment (0.22%) but slightly higher in the year following treatment (0.34%; p=0.004).

Further investigation is warranted, the investigators say.

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