Roaccutane and depression – is there a link?

The alleged connection between Isotretinoin (one of the brand names is Roaccutane, but there are other brands with the same active ingredient) and depression is controversial. While some studies report increased rates of depression (especially on high daily doses), other studies weren’t able to confirm this or even revealed reduced depression scores. Very recently a big meta-analysis (the ‘mother’ of all studies!) was published, which found no connection between isotretinoin and depression.

This also reflects my own extensive professional experience with the medication. In my clinic (where we tend to prescribe a low-dose treatment), I have not observed a link between the medication and depression.

Isotretinoin is a highly effective acne medication (and the only one that can actually switch off acne for good, rather than just controlling the acne, while you are on the medication) and I am glad that we have it at our disposal as dermatologists. We should not forget that acne is a disfiguring, potentially scaring facial skin condition with proven negative effects on the patients’ quality of life. And acne itself in fact has been shown unequivocally to be connected to depression and suicidal thoughts in a significant number of affected patients. So in my opinion, we can potentially spare more patients from depression with treating their acne, than those few (very unfortunate of course!) cases where the medication itself might be connected a lower mood. The latter is a minority of patients, especially on the low-dose regime.

Also, we have to think – what are the alternatives? Alternatives would include for example years and years on systemic antibiotics, which certainly is not ideal either and can be connected to various adverse effects.

If one of my three children would develop severe acne, I would certainly happily have them started on oral Isotretinoin, if needed…