Isotretinoin and Psychotic Mania

. 2014 Sep; 63(5): 555–556.
Published online 2015 Jun 5. doi: 10.7727/wimj.2012.256
PMCID: PMC4655693
PMID: 25781305

The Editor,

Sir,

Isotretinoin is a synthetic oral retinoid, which is effective against severe, recalcitrant, nodulocystic acne. Since it entered the market, it has been associated with a variety of adverse psychiatric effects, including depression, psychosis, mood swings, violent behaviour, suicide and suicide attempts (). In a retrospective review of 1743 patients, many side effects were reported. However, only 22 patients had mood swings ().

Three cases with bipolar disorder, who experienced an untoward psychiatric side effect while receiving isotretinoin treatment, were reported. In that study, psychiatric side effects of isotretinoin were examined in a larger group of patients with bipolar disorder than in previous research ().

In another review, isotretinoin (Roaccutane) ranks in the top 10 of the US Food and Drug Administration’s database of drugs associated with reports of depression and suicidal attempts (). However, this association is still controversial for the following reasons: (a) up to 5.6% of patients with moderate acne may have pre-existing suicidal ideations, (b) improvement of acne often reduces associated depression and (c) isotretinoin users are not more likely to have depression or commit suicide than those taking antibiotics for acne (). There are many case reports and reviews about the relationship between depression, suicide and isotretinoin.

We suggest that there is a relationship between isotretinoin and manic psychosis. Further studies are required to strengthen our findings.

TA is a 19-year old female student in law school. She was brought in by her family with complaints of insomnia, nervousness, fear and extreme religious pursuits.

Two weeks previously, she was restless and irritable and had bizarre behavior. She claimed that she was a special kind of human. Her symptoms increased in the last two days and her family reported that she had totally changed and became religious.

In her mental examination, she was irritable. There were spontaneous increases in her attention. She had paranoid and grandiose delusions and her insight was poor.

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