No increased suicide risk observed for isotretinoin users

Isotretinoin users do not have an increased risk for suicide or psychiatric disorders and may have a lower risk for suicide attempts, according to a review published online Nov. 29 in JAMA Dermatology.

Nicole Kye Wen Tan, from the National University of Singapore School of Medicine, and colleagues clarified the absolute and relative risks and risk factors associated with suicide and psychiatric disorders among isotretinoin users in a systematic review of randomized trials and observational studies. Twenty-five studies, with 1,625,891 participants, were included in the review; the meta-analysis included 24 studies.

The researchers found that the one-year pooled absolute risk of completed suicide, suicide attempt, suicide ideation, and self-harm were each less than 0.5 percent in two to eight studies, while that of depression was 3.83 percent in 11 studies. The likelihood of attempting suicide at two, three, and four years following treatment was lower among isotretinoin users versus nonusers (risk ratios [95 percent confidence intervals], 0.92 [0.84 to 1.00], 0.86 [0.77 to 0.95], and 0.85 [0.72 to 1.00], respectively).

No association was seen for isotretinoin with the risk for all psychiatric disorders. Studies with participants of older age showed a lower one-year absolute risk for depression, while a higher one-year absolute risk for completed suicide was seen in studies with a higher percentage of male participants.

"While our findings are reassuring, clinicians should continue to practice holistic psychodermatologic care and monitor patients for signs of mental distress during isotretinoin treatment," the authors write.

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