Onset of Kleine-Levin Syndrome in association with isotretinoin treatment

Evaluation of isotretinoin effects on depression, sleep apnea and sleep quality

BACKGROUND

Isotretinoin is used to treat severe acne, treatment-resistant moderate acne, and acne that leads to scarring or psychological distress. It has many side effects and is also associated with depression, sleep apnea, and sleep disturbances.

OBJECTIVES

In this study, we aimed to evaluate the effects of isotretinoin on depression, sleep apnea, and sleep quality.

METHODS

A total of 42 patients diagnosed with acne and started isotretinoin treatment were included in the study. In order to compare the effects of isotretinoin, patients were asked to fill out a questionnaire containing the Beck Depression Inventory (BDI), the Berlin Questionnaire (BQ), and the Pittsburg Sleep Quality Index (PSQI) at baseline and third months of treatment.

RESULTS

There was no statistically significant difference in BDI, BQ, and PSQI scores between the 1st and 3rd months of treatment (p = .53, p = .5, p = .35).

CONCLUSION

This study showed that isotretinoin had no significant effects on depression and sleep quality.

Psychiatric and Developmental Effects of Isotretinoin (Retinoid) Treatment for Acne Vulgaris

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Isotretinoin teratogenicity well established; psychiatric effects documented, controversial

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Disturbed retinoid signaling implicated in isotretinoin teratogenic and psychiatric effects

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Effect of genetics on susceptibility to psychiatric side effects is possible, not yet known

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Postnatal neurocognitive effects of isotretinoin not yet established

Background

An association between isotretinoin (13-cis-retinoic acid, sold under trade names including Accutane [Hoffmann-La Roche Inc, Basel, Switzerland]) and birth defects, depression, and suicide is well documented but controversial. A link to psychosis and exacerbation of bipolar symptoms is less extensively addressed in the literature.

Objective

Given recent conceptualization of psychotic disorders as neurodevelopmental, and current interest in possible shared etiology of different neurodevelopmental disorders such as psychosis, autism, and intellectual disability, this review concurrently examines the literature on developmental (primarily teratogenic) and psychiatric side effects of isotretinoin exposure. The goal of concurrent review is to identify shared mechanisms in the literature that may inform future efforts to clarify the neurocognitive and psychiatric effects of isotretinoin exposure at different developmental stages or given different genetic backgrounds.

Methods

Literature was obtained by PubMed search for the term isotretinoin in combination with each of the terms psychosis, psychiatric, and teratogenic. Resulting articles met inclusion criteria for review if they addressed psychiatric side effects of isotretinoin treatment or the neurobehavioral teratology of isotretinoin.

Results

The association of isotretinoin exposure with prenatal developmental toxicity is well established. Although numerous reports also link isotretinoin treatment with psychiatric side effects, this association remains controversial.

Conclusions

The extent to which isotretinoin influences pediatric and adult development and cognition, and whether and why certain individuals may be susceptible to psychiatric side effects, remains to be clarified. Curr Ther Res Clin Exp. 2019; 80:XXX–XXX)

Psychiatric disorders, acne and systemic retinoids: comparison of risks

BACKGROUND

The link between isotretinoin, treatment of a severe form of acne, and psychiatric disorders remains controversial, as acne itself could explain the occurrence of psychiatric disorders. This study aims at assessing the disproportionality of psychiatric adverse events reported with isotretinoin in the French National PharmacoVigilance Database, compared with other systemic acne treatments and systemic retinoids.

MATERIALS AND METHODS

Data were extracted from the French National PharmacoVigilance Database for systemic acne treatments, systemic retinoids and drugs used as comparators. Each report was subjected to double-blind analysis by two psychiatric experts. A disproportionality analysis was performed, calculating the number of psychiatric ADRs divided by the total number of notifications for each drug of interest.

RESULTS

Concerning acne systemic treatments: all 71 reports of severe psychiatric disorders involved isotretinoin, the highest proportion of mild/moderate psychiatric adverse events was reported with isotretinoin (14.1%). Among systemic retinoids, the highest proportion of severe and mild/moderate psychiatric events occurred with isotretinoin and alitretinoin.

CONCLUSION

Our study raises the hypothesis that psychiatric disorders associated with isotretinoin are related to a class effect of retinoids, as a signal emerges for alitretinoin. Complementary studies are necessary to estimate the risk and further determine at-risk populations.

Effects of isotretinoin treatment on sleep in patients with severe acne: a pilot study

BACKGROUND

  There are a few case reports in literature that isotretinoin treatment may alter sleep architecture. Also studies in mice suggest a role of retinoids in the contribution of delta oscillations to the sleep electroencephalography.

OBJECTIVES

  The aim of this study was to investigate the effect of isotretinoin treatment on sleep architecture using polysomnography (PSG).

PATIENTS AND METHODS

  Twelve severe acne vulgaris patients without any psychiatric and sleep disorders were treated with 0.5 mg/kg of isotretinoin. Clinician-administered acne questionnaire, psychiatric examination, Epworth sleepiness scale and PSG recordings were performed after the first month of treatment.

RESULTS

  Sleep efficiency was increased from 83.5% (62.8-89.0%, quartiles) to 89.5% (81.5-93.5%, quartiles; P = 0.036) and sleep latency decreased from 18.0 min (11.1-36.3, quartiles) to 15.5 min (9.3-19.0, quartiles; P = 0.023) following 1-month isotretinoin treatment. There were no significant changes in other sleep parameters of PSG and scores of Epworth sleepiness scale.

CONCLUSIONS

  This study suggests that isotretinoin treatment slightly improves night-time sleep without any effects on sleep stages and daytime sleepiness.