Isotretinoin is a retinoid used for the treatment of severe acne.Isotretinoin is a retinoid (derives from vitamin A, and is found in small quantities naturally in the body) used for the treatment of severe acne. It can be also used in other cases.
istretinoin

istretinoin

Isotretinoin depression

Isotretinoin depression




Appropriate Monitoring is KeyData have failed to show a direct relationship between isotretinoin use and depression or suicide, but the cumulative evidence suggests patients with severe acne require careful monitoring. In fact, a new study shows a correlation between acne severity and depression and that acne treatment improves QoL.10 Furthermore, a new, large study has failed to identify a link between isotretinoin use and suicide and found that the attempted suicide risk in severe acne patients actually was lower during treatment compared to after treatment. Conventional dosing of isotretinoin ranges from 0.5 to 1.0mg/kg per day to reach a total cumulative dose of 120 to 150mg/kg, usually obtained in 16-32 weeks. To minimize the risk of adverse events (including skin dryness and irritation, cheilitis, etc.), low-dose isotretinoin (ranging from 0.25 to 5mg/kg/day) has been widely adopted. A recent comparative study found no statistical difference in efficacy between patients treated with traditional isotretinoin doses (0.5- 1.0mg/kg/day) and those treated with low isotretinoin doses (0.25-0.4mg/kg/day). However, there was higher patient satisfaction in the low dose group. Moreover, both continuous dosing regimens were significantly more effective than an intermittent dosing regimen (0.5-0.7mg/kg/day for one week every four weeks.MMS: ErrorOur apologies. An error occurred while setting your user cookie. Please set your browser to accept cookies to continue. NEJM.org uses cookies to improve performance by remembering your session ID when you navigate from page to page. This cookie stores just a session ID; no other information is captured. Accepting the NEJM cookie is necessary to use the website.Acute Depression and Isotretinoin INFORMATION FOR HEALTH PROFESSIONALSIsotretinoin (Accutane) is an extremely effective anti-acne preparation. However, in a small number of patients (less than 1%) it may be associated with symptoms of a major depressive episode. Symptoms resolve rapidly (within 2-7 days) on discontinuation of the medicine. After a period off medication, it is worthwhile recommencing therapy at a lower dose.Two of the seven patients had a prior history of depression. The symptoms of depression occurred during the first course of isotretinoin in five patients, and in the second or third course in the remaining two patients. The seven patients voluntarily reported the following characteristic symptoms of a major depressive episode: fatigue (5), irritability (4), decreased concentration (4), sadness (4), crying spells (3), loss of motivation (3), forgetfulness (2), suicidal ideation (1), anhedonia (1) abnormal dreams (1) and fear of going insane (1). All symptoms resolved within 2 to 7 days of discontinuing the medicine. One patient was rechallenged several months later, with recurrence of the depressive symptoms during the third month of his second course of therapy.Acne, Isotretinoin and Depression INFORMATION FOR HEALTH PROFESSIONALS* 2003;41:76-78, and has been reprinted here with kind permission from Which? Ltd, 2 Marylebone Road, London NW1 4DF, United Kingdom.Most patients with mild acne (i.e. few to several papules or pustules, but no nodules/cysts) or moderate acne (several to many papules and pustules, plus few to several nodules/cysts) manage themselves or are treated in primary care with topical antimicrobials, keratolytics or retinoids and/or oral antibacterials. Some of these case reports fulfilled criteria suggesting a causal association: depression beginning or worsening after starting the drug, improvement in symptoms after withdrawal of the drug, and worsening of symptoms when the drug was reintroduced. However, it is not obvious how isotretinoin could cause such effects, particularly where depression or suicide occurs months after stopping the drug. The reports included 37 patients who committed suicide, of whom 24 were still taking the drug (median duration of treatment 3 months) and 13 had stopped (suicide occurred a median of 2.5 months after stopping isotretinoin). In all, 22% of these patients had a history of psychiatric illness and a further 40% had other factors that could have contributed to the suicide. Estimates of the numbers of suicides that could be expected in this population in the absence of any predisposing effect of isotretinoin during the same time period varied between 6 (based on comparisons with other drugs monitored by the FDA) and 400 (using national incidence rates), compared with the 37 observed. The authors therefore suggested that the number of suicides reported did not exceed that predicted, although they acknowledged the possibility of considerable under-reporting of suicide to the FDA.

isotretinoin depression

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Isotretinoin

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