CAN LOW DOSE OF ISOTRETINOIN CAUSE DEPRESSION

Background: Depressive symptoms may associate with the daily recommended dose of Isotretinoin for nodulocystic acne. Does reduce the dose will reduce the incidence of depressive symptoms is still not clearly understood. Study objective: To compare the types and frequency of depressive symptoms among patients with nodulocystic acne receiving three different low doses of isotretinoin (10mg daily, 20mg every other day, and 20mg daily). Study design: Open randomized clinical trial. Study setting: Dermatology clinic at Ibn Sina teaching hospital Patients & methods: 169 patients with severe nodulocystic acne were randomly assigned to one of three isotretinoin regimen groups as follows: 10 mg daily (n=46), 20mg alternate day (n=58), and 20 mg daily (n=65). After a month of treatment, the patient assessed for degree of improvement of acne and incidence of depressive symptoms Results: The frequencies of depressive symptoms irrespective to the group were as follows: crying in 36 (21.3%), anger in 35 (20.7%), sleep disturbance in 32 (18.9%), isolation in 29 (17.1%), and sadness in 20 (11.8%) of patients. The frequency of crying, anger, and sadness was significantly rose with an increased dose of isotretinoin from 10mg to 20mg daily (p-value equal to 0.02, 0.02, and 0.001 respectively). The summated depressive symptoms rose from (0.52 symptoms) in 10 mg daily to (1.19 symptoms) in 20 mg daily dose and the difference was statistically significant. Conclusion: Depressive symptoms increased gradually with an increased dose of isotretinoin and reducing the dose to the least effective dose is mandatory. Key Words: isotretinoin, dose regimen, depression, nodulocystic acne.