Isotretinoin and the controversy of psychiatric adverse effects.
Isotretinoin is a synthetic oral retinoid that has great efficacy against severe, recalcitrant, nodulocystic acne. Since its introduction to the market, it has been associated with a variety of adverse psychiatric effects, including depression, psychosis, mood swings, violent behavior, suicide, and suicide attempts. A MEDLINE review was performed to compile all case reports, case series, adverse drug event reportings, and prospective and retrospective studies relating psychiatric adverse events to isotretinoin. In addition, literature linking a biological mechanism for psychiatric adverse events to retinoid signaling pathways was also reviewed. Although a variety of anecdotal and epidemiologic studies are available, the overall lack of concrete scientific data limits any conclusion that can be drawn about a causal relationship between istotretinoin and psychiatric adverse events. Several lines of evidence link retinoid signaling to theorized psychiatric pathogenesis, but are limited in their applicability to adult neurophysiology.
Strahan
Jamison E
JE
Department of Dermatology, School of Medicine, University of Texas Medical Branch, Galveston, USA. jstrahan@hotmail.com
Raimer
Sharon
S
D000152:Acne Vulgaris / Q000188:drug therapy / Q000523:psychology; D001921:Brain / Q000378:metabolism; D003879:Dermatologic Agents / Q000009:adverse effects* / Q000494:pharmacology; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects* / Q000494:pharmacology; D001523:Mental Disorders / Q000139:chemically induced*; D018168:Receptors, Retinoic Acid / Q000502:physiology
D003879:Dermatologic Agents; D018168:Receptors, Retinoic Acid; D015474:Isotretinoin