Isotretinoin Often Continued Despite Mood Concerns

Image Credit: © LIGHTFIELD STUDIOS - stock.adobe.com

Isotretinoin remains one of the most effective treatments for moderate to severe acne vulgaris, particularly in cases resistant to conventional therapy. However, its use is often complicated by concerns over psychiatric adverse effects, particularly mood disturbances.¹ Despite robust evidence from systematic reviews indicating no consistent association between isotretinoin and increased risk of depression—and even suggestions of mood improvement during therapy—the medication is still frequently discontinued when patients report psychological symptoms.²

Methods and Materials

A recent retrospective study examined factors associated with completion of isotretinoin therapy in patients who reported mood disturbances early during treatment. The aim was to assess the viability of continuing isotretinoin despite such symptoms and to characterize clinical and demographic predictors of treatment completion in this cohort.³

Researchers reviewed the electronic medical records of a large dermatology clinic, identifying 532 adult patients with acne vulgaris who initiated isotretinoin therapy and reported mood disturbances within 3 months of starting treatment. To reduce confounding, patients with a history of mood disorders or those who reported suicidal ideation were excluded. All cases involved a first course of isotretinoin, prescribed at doses ranging from 0.2 to 0.7 mg/kg. Completion of therapy was defined as reaching a cumulative dose of 150 mg/kg for facial and truncal acne or 120 mg/kg for facial acne only.

Results

Among the 532 cases, 253 patients completed the full course of therapy. The remaining patients either discontinued entirely (140 cases) or continued on a reduced dose (264 cases). Importantly, no episodes of self-harm or suicide were reported throughout the treatment period.

Several factors were significantly associated with higher likelihood of treatment completion. These included patient age of 25 years or older (p = 0.002), family history of acne vulgaris (p = 0.040), noticeable therapeutic response within the first 3 months (p = 0.007), and formal psychiatric consultation (p < 0.001). These findings suggest that a combination of patient maturity, perceived treatment efficacy, familial experiences with acne, and access to psychiatric support may positively influence adherence to isotretinoin therapy even in the presence of mood disturbances.

Interestingly, no significant association was found between dose reduction and treatment completion, indicating that simply lowering the dose does not necessarily resolve adverse effects sufficiently to encourage continuation. This supports the idea that adverse psychological reactions, where they occur, may be idiosyncratic rather than dose-dependent.

Additionally, abnormal blood test results—commonly monitored during isotretinoin therapy due to potential effects on liver function and lipid profiles—did not significantly influence treatment cessation. Previous studies have shown that such biochemical changes are typically mild, reversible, and rarely justify discontinuation in otherwise healthy individuals.

This study also highlights behavioral differences among age groups. Older patients were more likely to value medication safety practices and adhere to follow-up protocols. They may also have had fewer alternative treatment options remaining, increasing their motivation to persevere with isotretinoin.

Moreover, researchers found the presence of a family history of acne may provide additional psychological context. Patients aware of relatives who endured mood symptoms while undergoing isotretinoin therapy—and who ultimately benefited—might feel more encouraged to continue. Conversely, negative family experiences with acne-related mood disorders, absent isotretinoin exposure, could further diminish the perceived culpability of the drug.

Conclusion

This study provides evidence that isotretinoin therapy can be completed by a substantial proportion of acne patients who report mood disturbances early in treatment. Key factors such as older age, favorable early clinical response, family history of acne, and psychiatric support were associated with higher rates of treatment adherence. These findings support a nuanced, individualized approach to isotretinoin therapy, emphasizing continued monitoring and support rather than premature cessation based solely on mood-related symptoms.

References

1. Kazemi T, Sachsman SM, Wilhalme HM, Goh C. Isotretinoin therapy: A retrospective cohort analysis of completion rates and factors associated with nonadherence. J Am Acad Dermatol. 2018;79(3):571-573. doi:10.1016/j.jaad.2018.02.032
2. Huang YC, Cheng YC. Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis [published correction appears in J Am Acad Dermatol. 2018 Feb;78(2):431. doi: 10.1016/j.jaad.2017.10.041.]. J Am Acad Dermatol. 2017;76(6):1068-1076.e9. doi:10.1016/j.jaad.2016.12.028
3. Farrell J, Stewart TJ, Rosen R. Factors Associated With Completion of Isotretinoin Therapy in Acne Patients Reporting Mood Disturbance. J Cosmet Dermatol. 2025 Apr;24(4):e70106. doi: 10.1111/jocd.70106. PMID: 40243124; PMCID: PMC12004431.