Psychiatric reactions to isotretinoin in patients with bipolar disorder.
BACKGROUND
Isotretinoin (Accutane(R)) has been available for the treatment of severe cystic acne for about twenty-five years. There have been several reports of adverse psychiatric reactions to isotretinoin, including depressive symptoms and suicide. However, there have been only three case reports of patients with bipolar disorder (BD) who experienced an untoward psychiatric side effect while receiving isotretinoin treatment. In this study, the psychiatric side effects from isotretinoin were assessed in a larger group of BD patients than has previously been reported.


METHODS
A retrospective chart review of 300 BD outpatients identified ten patients treated with isotretinoin.


RESULTS
Nine of these ten patients experienced a significant worsening of mood symptoms, and three developed suicidal ideation. Eight experienced a reversal of the relapsed mood symptoms when the isotretinoin was discontinued, whether prematurely or after a full course.


CONCLUSIONS
The limitations of this study include small sample size, retrospective data collection, absence of double-blind controlled design, and inability to control for spontaneous mood episodes in patients with BD.


CONCLUSIONS
These results indicate that BD patients treated with isotretinoin for acne are at risk for clinically significant exacerbation of mood symptoms, including suicidal ideation, even with concurrent use of psychiatric medicines for BD. The clinical implications of this study are especially relevant to the treatment of patients with BD because acne usually occurs during adolescence, which is often the age of onset of BD and because a common side effect of lithium (a standard treatment for BD) is acne.
Schaffer
Linda C
LC
Sutter Community Hospitals, United States. schafferpsych@sbcglobal.net
Schaffer
Charles B
CB
Hunter
Susan
S
Miller
Amber
A
D000152:Acne Vulgaris / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D000339:Affect / Q000187:drug effects; D001714:Bipolar Disorder / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000139:chemically induced* / Q000523:psychology; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008499:Medical Records; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
D003879:Dermatologic Agents; D015474:Isotretinoin