Depression and isotretinoin - another reason for low dose

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Depression and isotretinoin – another reason for low dose 

An Australian consensus group agreed that severe acne may be associated with depression, suicidality and decreased quality of life.1 Both severe acne and depression are highly prevalent in the teenage demographic.

Prior mental health diagnoses or symptoms are not absolute contraindications to isotretinoin prescription, with each case considered independently. Patients who have known depression should be monitored with standard mood inventories.

Evidence also suggests that using low dose isotretinoin is associated with significantly fewer adverse effects, including depression, while remaining effective. The advice is still to start with doses of 10 mg/day, continuing until all the active acne lesions have resolved, with a further 2–4 months perhaps at the lower dose of 5–10 mg/day (or 10 mg alternate day) to reduce the risk of relapse and help with resolution of acne scarring.2 

For patients who develop mental health symptoms, any rechallenge of isotretinoin should be negotiated with the patient and their family/ whānau.1  

References:

  1. Rowe C et al. Isotretinoin and mental health in adolescents: Australian consensus
  2. Rademaker M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us?

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

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As published in NZ Doctor 14/12/2016