The effect of isotretinoin administration on depression symptom level, suicide risk scale score and life quality in patients with acne vulgaris

Background: Isotretinoin is the only drug effective against all factors that play a role in the pathogenesis of acne. It is widely used not only in severe nodulocytic acne but also psychologically problematic acne forms, which cause scarring, which do not respond to topical agents and other conventional treatments. Isotretinoin is a known human teratogen, and numerous side effects including dry mucous membranes, headache, alopecia, hypertriglyceridemia and joint and muscle pain have been reported to the Food and Drug Administration (FDA). The FDA also has received reports of psychiatric adverse events, most notably depression and suicide, in patients treated with isotretinoin.Psychiatric side effects, most notably suicide ideation and depression are being investigated by many researchers in patients treated with isotretinoin to guide risk management. Aim: The aim of this prospective study was to investigate the proposed association between isotretinoin therapy and the risk of depression, psychological symptoms, life quality, suicide and attemped suicide. Material and methods: 120 acne vulgaris patients (age range: 18-45 years), who had attended the outpatient clinic of the Department of Dermatology at Atatürk University medical faculty between april 2016 – december 2016 , were enrolled in this study. Acne severity was graded according to the five-stage global system at the "Food and Drug Administration" (FDA) acne rating in 2002, and isotretinoin treatment was started for those with moderate to severe acne. Patients who are decided to start isotretinoin treatment were unresponsive to several topical acne preparations or systemic antibiotics treatments and had indication for isotretinoin use. İsotretinoin treatment was started at the dose of 0.5 mg/kg per day in the first month of therapy, treatment was continued by increasing the dose to 0.75-1 mg/kg per day in the following months. Treatment term was determined according to cumulative dose (150 mg/kg ). İsotretinoin was administered in two divided doses with food for 24 weeks. 110 patient completed study, 10 patient discontinued the therapy because of noncompliance follow up visits. The evalution of patients were done at the initial appointment and the end of the 24 weeks by using AQLI ( Acne quality life index) , Beck depression inventory (BDI) , Beck suicidal intention scale (BSIS) and symptom checklist 90 revised (Scl 90 R). SPSS was used for statiscal evaluation . P <0.05 was considered significant. Result: The mean score of the Acne Quality Life Index was significantly decreased after the treatment compared to the pre-treatment. The mean score of Beck Depression Scale was significantly decreased after treatment. The scores of SCL-90 r somatization, obsessions, depression, anxiety, anger and general symptom index decreased significantly after treatment but no significant difference was found in the anxiety, psychotic mood, paranoid mood and phobic thought mean scores before and after treatment. Patients who have suicidal ideation was not included in the study and at the end of the 24 weeks suicide thought did not develop in our patients, no cases of suicide were found. Conclusion: The datas we obtained in this study do not support the thesis that isotretinoin has a tendency to depressive symptoms and suicidal ideation. On the contrary, it has been found that the treatment improves the quality of life significantly and reduces the anxiety and depression findings with improvement of the body image.