By Rajnish Mago, MD (bio)
Clinical situation:
The dermatologist for one of my patients who has bipolar disorder, which is currently well-controlled, called me regarding wanting to start our mutual patient on isotretinoin for the treatment of his severe acne that had not responded to either topical treatment or a long course of doxycycline.
The doctor said to me that even though early studies had shown that isotretinoin was associated with depression and suicidality in a few cases, subsequent studies have shown the exact opposite—that isotretinoin treatment is associated with improvement in depression. Based on this, the dermatologist was not convinced that there really was an association between isotretinoin and depression, and wanted to proceed with prescribing him isotretinoin. I was asked if I was “comfortable” with this. What would you have said in this situation?
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