Use of isotretinoin and risk of depression in patients with acne: a systematic review and meta-analysis

OBJECTIVE: This study aimed to investigate the association between the use of isotretinoin and the risk of depression in patients with acne. DESIGN: This was a meta-analysis in which the standardised mean difference (SMD) and the relative risk (RR) were used for data synthesis employing the random-effects model. SETTING: Studies were identified via electronic searches of PubMed, Embase and the Cochrane Library from inception up to 28 December 2017. PARTICIPANTS: Patients with acne. INTERVENTIONS: Studies comparing isotretinoin with other interventions in patients with acne were included. RESULTS: Twenty studies were selected. The analysis of 17 studies showed a significant association of the use of isotretinoin with improved symptoms compared with the baseline before treatment (SMD = −0.33, 95% CI −0.51 to −0.15, p<0.05; I (2)=76.6%, p<0.05)). Four studies were related to the analysis of the risk of depression. The pooled data indicated no association of the use of isotretinoin with the risk of depressive disorders (RR=1.15, 95% CI 0.60 to 2.21, p=0.14). The association of the use of isotretinoin with the risk of depressive disorders was statistically significant on pooling retrospective studies (RR=1.39, 95% CI 1.05 to 1.84, p=0.02), but this association was not evident on pooling prospective studies (RR=0.85, 95% CI 0.60 to 2.21, p=0.86). CONCLUSIONS: This study suggested an association of the use of isotretinoin in patients with acne with significantly improved depression symptoms. Future randomised controlled trials are needed to verify the present findings.