Isotretinoin and the risk of psychiatric disturbances: A global study shedding new light on a debatable story

Khalaf Kridin, Ralf J. Ludwig

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Introduction: Isotretinoin-related risk of depression and suicidal behavior is a topic of inconclusiveness. A crucial knowledge gap exists in defining the association of isotretinoin with other psychiatric comorbidities. Objective: To evaluate the risk of psychiatric outcomes among patients with acne treated with isotretinoin versus oral antibiotics. Methods: A global population-based retrospective cohort study enrolled 2 groups of patients with acne managed by isotretinoin (n = 75,708) and oral antibiotics (n = 75,708). Patients were compared regarding the risk of 9 psychiatric outcomes. Results: Relative to those treated with oral antibiotics, patients prescribed isotretinoin experienced lower risk of depression (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.87-0.93; P <.001), but comparable risk of major depressive disorder (HR, 0.97; 95% CI, 0.92-1.03; P =.318). Risk of suicidal attempts was comparable between groups (HR, 0.97; 95% CI, 0.85-1.11; P =.663), despite the elevated risk of suicidal ideation in those under isotretinoin (HR, 1.41; 95% CI, 1.32-1.50; P <.001). Patients under isotretinoin had lower risk of post-traumatic stress disorder (HR, 0.75; 95% CI, 0.68-0.82; P <.001), anxiety (HR, 0.84; 95% CI, 0.82-0.87; P <.001), bipolar disorder (HR, 0.65; 95% CI, 0.59-0.72; P <.001), schizophrenia (HR, 0.60; 95% CI, 0.48-0.76; P <.001), and adjustment disorder (HR, 0.82; 95% CI, 0.77-0.87; P <.001). Limitations: Retrospective data collection. Conclusion: Isotretinoin confers lower risk of 6 psychiatric comorbidities and comparable risk of suicidal attempts.

Original languageEnglish
Pages (from-to)388-394
Number of pages7
JournalJournal of the American Academy of Dermatology
Issue number2
StatePublished - Feb 2023

Bibliographical note

Publisher Copyright:
© 2022 American Academy of Dermatology, Inc.


  • Acne
  • depression
  • isotretinoin
  • oral antibiotics
  • psychiatric disturbances
  • suicidal attempt
  • suicidal ideation


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