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 randomeffects 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.