A prospective trial of the effects of isotretinoin on quality  of life and depressive symptoms.
BACKGROUND
Isotretinoin is an efficacious treatment for acne, but has been controversially linked with depression.


OBJECTIVE
This study aimed to examine the effects of isotretinoin on quality of life(QoL) and depression using a prospective design.


METHODS
The WHOQOL-BREF QoL measure and Centre for Epidemiological Studies Depression Scale were administered to consecutive outpatients with acne who were prescribed either isotretinoin (n = 65) or antibiotic treatment (n = 31).Patients and physicians rated acne severity independently. Groups were compared at baseline with a matched community sample (n = 94) and measurements repeated at 3 months for treatment groups.


RESULTS
There were no differences between the three groups at baseline in terms of age, gender, depression or overall QoL. Acne was more severe in the treatment groups (P < 0·001). Depression was negatively correlated with QoL (P < 0·001)and hence was included as a covariate in repeated-measures analyses of QoL.Acne improved over time in both treatment groups (F = 48·2, P < 0·001). There was no detectable deterioration in depression score in either group (F = 1·1, not significant). QoL in the physical and social domains improved (P < 0·001) while psychological and environmental QoL was unchanged over time. The improvement in social QoL was greater in the isotretinoin group (P < 0·05). Those patients with higher baseline depression scores showed greater improvements in physical, psychological and social QoL (P < 0·001).


CONCLUSIONS
Treatment of acne improves QoL, particularly in those with more depressive symptoms at the outset. Mood deterioration was not detected, but the possibility of subtle or rare mood effects of isotretinoin cannot be ruled out.
Kinghorn Dermatology Unit, Royal United Hospital, Bath BA1 3NG, UK. ejsefton@doctors.org.uk
E J
EJ
McGrath
C R
CR
Lovell
F
F
Gillison
A
A
Darvay
J R
JR
Hickey
S M
SM
Skevington
D000152:Acne Vulgaris / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003863:Depression / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D003879:Dermatologic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D055815:Young Adult
D000900:Anti-Bacterial Agents; D003879:Dermatologic Agents; D015474:Isotretinoin