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Occurrence of Mental Health Symptoms in Adolescents Receiving Isotretinoin Therapy
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Isotretinoin treatment for acne can reduce adverse psychiatric outcomes in adults, but there has been little investigation of the incidence of psychiatric outcomes in treated adolescents.
METHODS
This retrospective cohort study using the Rochester Epidemiology Project identified 606 patients aged 12-18 prescribed isotretinoin over a 10-year period between January 1, 2008 and December 31, 2017. Medical records were reviewed to identify psychiatric diagnoses before and during isotretinoin therapy, as well as psychiatric symptoms not captured by formal diagnoses and changes to isotretinoin dosing because of psychiatric diagnoses or symptoms.
RESULTS
One hundred seventy-seven (29.2%) had a psychiatric diagnosis prior to isotretinoin initiation, but 98 (16.2%) had a new psychiatric diagnosis or psychiatric symptom while taking isotretinoin. Patients with a psychiatric history were no more likely than those without to receive a new psychiatric diagnosis during treatment (4.5% vs. 3.7%; p = .650), but did experience more psychiatric symptoms, primarily low mood and mood swings (23.7% vs. 7.7%; p < .001). Only 25.5% of the 98 with a new psychiatric diagnosis or psychiatric symptom had a subsequent dose change. A dose change was more likely if patients received a new psychiatric diagnosis (41.7% vs. 20.3%; p = .037) or patients did not have a psychosocial explanation for psychiatric symptoms (34.4% vs. 10.8%; p = .009).
CONCLUSIONS
A substantial proportion of adolescent patients prescribed isotretinoin had a prior psychiatric diagnosis. This predicts more psychiatric symptoms during isotretinoin treatment. Adolescents with a psychiatric history who have worsening symptoms and those with new-onset psychiatric symptoms would benefit from close monitoring while taking isotretinoin.
Additional Info
The occurrence of mental health symptoms in isotretinoin-treated adolescents
Pediatr Dermatol 2024 Mar 18;[EPub Ahead of Print], K Miller, A McKean, J Hand, S Rackley, JG Leung, A LeMahieu, J Geske, JM BostwickFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The article by Miller et al falls under the category of a retrospective documentation of statistics as opposed to a piece that answers questions to advance, define, or change clinical practice. However, the publication does highlight some interesting observations. Mainly, it documents that, in Rochester, Minnesota, over a 10-year period that ended 6.5 years ago, a significant percentage (29.2%) of 606 adolescents placed on isotretinoin had pre-existing psychiatric diagnoses. Moreover, 16.2% of the patients had a new psychiatric diagnosis or psychiatric symptom while on isotretinoin. Patients who had a psychiatric diagnosis before starting isotretinoin were significantly more likely to have new psychiatric symptoms than those who had no prior psychiatric diagnosis (23.7% vs 7.7%). The main symptoms were low mood or mood swings. What this article does not tell us is whether any of these psychiatric symptoms or diagnoses were related to acne or isotretinoin therapy. By the authors' own admission, the study design lacked any control groups, either adolescents with acne under treatment with medications other than isotretinoin or those without acne. Furthermore, given the demographics of the study group (92% Caucasian individuals), it is hard to know the extent to which the data can be generalized to the greater US population. There are other recent publications that do a better job of documenting psychiatric issues and diagnoses in patients on isotretinoin.1,2 Although these articles did not focus on adolescents, they utilized appropriate control groups to calculate the relative risks of various psychiatric issues and diagnoses encountered in patients taking isotretinoin.
In summary, the article by Miller et al successfully documents baseline percentages of psychiatric diagnoses among adolescents taking isotretinoin over a 10-year period along with the development of new diagnoses and symptoms. However, it does not provide particularly useful information that enhances our practices when evaluating these adolescents. Our approach to adolescents and all patients undergoing treatment with isotretinoin basically remains the same: beware of the potential for the development of psychiatric symptoms, especially in patients with a pre-existing psychiatric diagnosis.
References