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January 2008

Treating Behavioral Problems in Dementia
No drug is clearly efficacious for behavioral problems in dementia, and all are associated with significant risks.

Prolactin Elevation and Antipsychotics
Risperidone (Risperdal) seems to increase prolactin more than conventional and other second-generation antipsychotics; adjunctive aripiprazole (Abilify) may lower antipsychotic-induced hyperprolactinemia.

In Brief
Atomoxetine Effective for ADHD in Preschool Children; Excessive Body Weight Increases Risk of Dementia

Treating Adolescent Mania
Olanzapine (Zyprexa) effectively treats adolescent bipolar disorder but appears to cause harmful medical consequences in young patients.

Isotretinoin and Depression
Depression is a possible side effect of treatment with isotretinoin (Accutane and others).

Isotretinoin and Depression

January 2008

Isotretinoin (Accutane and others) is used to treat severe, recalcitrant, nodular acne. Frequent case reports suggest that depression is one of its side effects. Some studies have not confirmed this association, but between 1982 and 2000 the US Food and Drug Administration (FDA) received reports of 394 cases of depression and 37 suicides in patients treated with isotretinoin. In Canada, 56 (25%) of 222 reported adverse events associated with isotretinoin over 20 years were psychiatric.

From a Canadian database, Azoulay and coworkers identified over 30,000 patients who had received at least one prescription for isotretinoin between 1984 and 2003.1 Of these, they found 126 patients who subsequently had a first diagnosis or hospitalization for depression or a new antidepressant prescription.

In a case-crossover method, the investigators compared a 5-month risk period immediately after isotretinoin was started with a 5-month control period before patients started taking the anti-acne medicine. The adjusted relative risk of patients developing depression was 2.6 times greater when they were taking isotretinoin than when they were not.

When a patient takes isotretinoin, the overall risk of becoming depressed is relatively small. Nonetheless, the risk does rise several fold. Presumably, patients who are vulnerable to depression are at greater risk. When taking a history from a depressed patient, consider concurrent treatment with isotretinoin as a possible causative factor.

1Azoulay L, Blais L, Koren G, LeLorier J, Berard A: Isotretinoin and the risk of depression in patients with acne vulgaris: A case-crossover study. J Clin Psychiatry, in press.