Isotretinoin and suicide risk

January 01, 0001

Isotretinoin and suicide risk

Concerns have been raised that isotretinoin may increase depression and risk of suicide attempt when used to treat patients with severe acne. These Swedish researchers examined the attempted suicide risk before, during, and after treatment with isotretinoin. They performed a retrospective cohort study linking an isotretinoin user registry with hospital discharge and cause of death. They found 5756 patients aged 15 to 49 years on isotretinoin for sever acne, and they were observed for 17?197 person years before, 2905 person years during, and 87,120 person years after treatment. Standardised incidence ratioes (observed number divided by expected number) of suicide attempts were calculated.

The researchers found: "128 patients were admitted to hospital for attempted suicide. During the year before treatment, the standardised incidence ratio for attempted suicide was raised: 1.57 for all (including repeat) attempts and 1.36 counting only first attempts. The standardised incidence ratio during and up to six months after treatment was 1.78 for all attempts and 1.93 for first attempts. Three years after treatment stopped, the observed number of attempts was close to the expected number and remained so during the 15 years of follow-up: standardised incidence ratio 1.04 for all attempts and 0.97 for first attempts. Twelve (38%) of 32 patients who made their first suicide attempt before treatment made a new attempt or committed suicide thereafter. In contrast, 10 (71%) of the 14 who made their first suicide attempt within six months after treatment stopped made a new attempt or committed suicide during follow-up. The number needed to harm was 2300 new six month treatments per year for one additional first suicide attempt to occur and 5000 per year for one additional repeat attempt."

The researchers concluded: "An increased risk of attempted suicide was apparent up to six months after the end of treatment with isotretinoin, which motivates a close monitoring of patients for suicidal behaviour for up to a year after treatment has ended. However, the risk of attempted suicide was already rising before treatment, so an additional risk due to the isotretinoin treatment cannot be established. As patients with a history of suicide attempts before treatment made new attempts to a lesser extent than did patients who started such behaviour in connection with treatment, patients with severe acne should not automatically have isotretinoin treatment withheld because of a history of attempted suicide."

While patients on isotretinoin are at increased risk of suicide attempt, it is not clear if the medication itself is increasing the risk.

For the full abstract, click here.

BMJ 341:c5812, 11 November 2010
© 2010 Sundström et al.
Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. Anders Sundström, Lars Alfredsson, Gunilla Sjölin-Forsberg, Barbro Gerdén, Ulf Bergman, Jussi Jokinen. Correspondence to A Sundström: [email protected]

Category: P. Psychological, S. Skin. Keywords: isotretinoin, acne, severe acne, suicide, suicide attempt, retrospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 30 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.