Up to the current time, a rate of 12 suicides per 8 million isotretinoin-treated patients has been documented. Half of these patients were on concomitant medications. (other depression medicines, thus was there some selection bias?) A small number of patients have reported that depression subsided when isotretinoin was withdrawn and recurred with treatment resumption. In the United States, 64 suicides occurred between 1991 and 1999 in patients who at one time took isotretinoin. Thirty occurred during treatment, 24 after treatment was stopped (6 months-10 years), and 10 occurred in patients whose treatment status was unknown.
These numbers must be compared with general suicide statistics in the United States. In total, 30,000 suicides occur per year (in the general population, the rate is 11.4 per 100,000). Eighty percent are males. Suicide is the third leading cause of death in the 15- to 24-year age group (6000 per year). So when isotretinoin patients are observed, the 64 total suicides must be compared with an expected suicide rate of more than 10 times that number .These data suggest that in these patients the suicides were likely due to factors other than isotretinoin treatment.The isotretinoin suicide rate of 1.8 per 100,000 is well below that of the general population, as noted above. In addition, in the isotretinoin patients, there was no alteration in the typical US pattern of suicide in terms of gender distribution, relationship to depression, underlying psychiatric disorders, or lack of warning signs (typical of youth suicide).
Depression showed a similar lack of correlation with isotretinoin treatment. In isotretinoin-treated patients, depression was reported in 1013 patients compared with the expected number of 182,500 in this patient population. Depression is a common diagnosis. In the United States, 10% to 20% of the population report experiencing depression at some time during their lives. Sixteen to twenty percent of 12- to 18-year-olds are given a diagnosis of some form of depression each year. In a large study of approximately 8000 isotretinoin users and 14,000 antibiotic users, no difference in relative risk for depression was found between the 2 groups. In view of these data, the risk of any true association between isotretinoin use and depression seems to be excessively small. However, these issues should be discussed with your doctor.