Mental health outcomes in acne patients treated with isotretinoin versus oral antibiotics: A retrospective study

Abstract Background: Isotretinoin is a widely prescribed treatment for severe acne vulgaris, but controversy about its potential psychiatric side effects has raised concerns. Prior studies have yielded mixed results, and further research is needed to clarify these associations. Objectives: This study evaluates the mental health outcomes of patients treated with isotretinoin compared to those receiving oral antibiotics. Methods: A retrospective cohort analysis was conducted using an electronic health records database. Patients diagnosed with acne vulgaris were grouped based on treatment with either isotretinoin or oral antibiotics. Psychiatric outcomes assessed included depressive episodes, major depressive disorder (MDD), suicidal ideation, anxiety disorder, posttraumatic stress disorder (PTSD), and bipolar disorder. Statistical comparisons were made using risk differences (RD), risk ratios (RR), odds ratios, Z -scores, and P values, with 95% confidence intervals. Results: The isotretinoin group demonstrated significantly lower incidence of all six psychiatric outcomes compared to the oral antibiotic group. Notably, patients receiving isotretinoin had reduced risks of depressive episodes (RD: −3.421%, RR: 0.571), MDD (RD: −1.446%, RR: 0.578), suicidal ideation (RD: −0.630%, RR: 0.550), anxiety disorder (RD: −5.471%, RR: 0.559), PTSD (RD: −0.777%, RR: 0.391), and bipolar disorder (RD: −0.662%, RR: 0.355), all with P < 0.0001. Conclusion: This analysis did not find evidence of increased risk of adverse psychiatric outcomes in patients taking isotretinoin compared to oral antibiotics. Instead, patients treated with isotretinoin exhibited lower rates of the measured health conditions compared to those treated with oral antibiotics. Future prospective studies should look to explore causal mechanisms and account for other confounding variables.