Mood swings: puberty or isotretinoin?

Children and adolescents with severe acne often receive isotretinoin. Could data from over 200 patients shed light on possible associations to moodswings?

Things to know about mood swings and isotretinoin:

Do mood swings and isotretinoin therapy go hand in hand?

Many adolescents and young adults suffer from acne vulgaris and quite a few of them are treated with isotretinoin. It is increasingly being discussed whether the drug is associated with mood swings or other psychiatric symptoms. A causal relationship has not yet been proven.

A recent study has analysed the data of over 200 people treated with isotretinoin and investigated affective symptoms such as depression, anxiety or emotional instability.

Mood swings are not uncommon

Overall, the researchers found signs of depressive symptoms or anxiety, increased aggression and emotional instability in around 10% of young people. In 88% of these patients, however, the psychiatric symptoms improved independently of their treatment and they were able to successfully complete their isotretinoin treatment.

Isotretinoin as a cause of depressive mood?

Whether or not the drug isotretinoin is the cause of the altered mood of those affected cannot be conclusively clarified. The fact that adolescents and young adults also experience emotional changes as part of the natural maturation process and that the entire spectrum of psychiatric symptoms can be present - not always with disease value - should certainly not be ignored. The underlying disease of severe acne can also favour depressive symptoms or anxiety.

Nevertheless, the study does shows that it is important to regularly screen young people being treated with isotretinoin for affective changes.

Conclusion for medical practice

Even if it has not yet been possible to prove a causal relationship between isotretinoin treatment and mood swings in children, adolescents and young adults, there is no doubt that these patients can certainly suffer from psychiatric symptoms. Therefore, every physician who prescribes isotretinoin in this age group should regularly screen his or her patients for affective symptoms and refer them to a specialist if necessary.

  1. Gradwohl K, Verghese M, Rosenblatt AE. Mood changes and clinical decision making in adolescent patients on isotretinoin therapy for acne vulgaris. Pediatr Dermatol. 2023 May-Jun;40(3):494-496. doi: 10.1111/pde.15324. Epub 2023 Apr 10. PMID: 37037198.