Wonder drug or a mental-health crisis

Aggressive behaviour is just one of the negative effects associated with Roaccutane or isotretinoin (used to treat severe acne). According to studies, the medicine has resulted in depression, aggressive behaviour, and suicide attempts. So, what happens if you encounter mental health side effects while on isotretinoin?

Isotretinoin, a synthetic oral retinoid and vitamin A derivative, is an isomer of retinoic acid that plays a role in cell proliferation and differentiation by regulating gene transcription, says Dr Neha Sharma, dermatologist, Estique Skin & Hair Clinic. “Used in the treatment of resistant advanced cystic acne and nodular acne since 1982, for patients with moderate to severe acne that is unresponsive to antibiotic treatment, the main treatment is oral isotretinoin,” says Dr Neha.

Mood-altering side-effects

The psychiatric side effects of isotretinoin use reported to the FDA between 1997 and 2017 rank these adverse outcomes as depression, suicidal ideation and attempts, emotional lability, anxiety disorders, insomnia, psychotic disorder, BP affective disorder, self-harming behaviour, attention deficit and hyperactivity disorder, and eating disorders.

“Although the link between isotretinoin and mental health or neuropsychiatric symptoms is well established, the cause is still debated. However, most people should be aware that if they have severe acne, they are more likely to suffer from disorders such as melancholy and anxiety,” says Dr Charan Teja Koganti, Consultant Psychiatrist, KIMS Hospitals.

In severe cases, suicidal thoughts may be present. “B efore starting a patient on isofretinoin, a dermatologist frequently refers them to a psychiatrist, who will investigate three issues. One is, do they currently have any depression symptoms? Did they have depression in the past? Do they have a family history of mood disorders or depression? Based on these three variables, we recommend starting with isocretinoin. Even after starting medication, some people—not everyone—may have aggression, confusion, psychosis, most typically despair, mood disturbances, mood swings, anxiety, and suicidality,” says Dr Charan, adding, “If you see any of these behavioural concerns or mood changes, you must immediately discontinue the medication and notify your dermatologist and psychiatrist.”

Warnings over acne drug

“Patients on isotretinoin therapy must be followed up against the development of psychiatric disorders, including psychotic mania attacks, with special attention on those who have a personal or family history of psychiatric disorders,” says Dr Neha Sharma, adding, “In the event of psychiatric disorders, discontinuing isotretinoin use and initiating psychiatric treatment with follow-up at short intervals should ensure rapid regression of psychiatric symptoms and regain of normal mental health.”

When isotretinoin use cannot be discontinued, it would be appropriate to start with psychiatric medications as required.

“It is imperative that the acne treatment in individuals with a personal or family history of psychiatric disorder be carried out conjointly with dermatology and psychiatry specialists to enable the rapid control of any psychiatric disorders in risk groups,” adds Dr Neha.

Dermatologists will not give isotretinoin to anyone who does not appear to be entirely stable or whose acne is not severe enough because of its mood-altering side effects.” — Dr Neha Sharma, dermatologist