Sutter Community Hospitals, United States.
J Affect Disord. 2010 May;122(3):306-8. doi: 10.1016/j.jad.2009.09.005. Epub 2009 Sep 27.
Isotretinoin (Accutane(R)) has been available for the treatment of severe cystic acne for about twenty-five years. There have been several reports of adverse psychiatric reactions to isotretinoin, including depressive symptoms and suicide. However, there have been only three case reports of patients with bipolar disorder (BD) who experienced an untoward psychiatric side effect while receiving isotretinoin treatment. In this study, the psychiatric side effects from isotretinoin were assessed in a larger group of BD patients than has previously been reported.
A retrospective chart review of 300 BD outpatients identified ten patients treated with isotretinoin.
Nine of these ten patients experienced a significant worsening of mood symptoms, and three developed suicidal ideation. Eight experienced a reversal of the relapsed mood symptoms when the isotretinoin was discontinued, whether prematurely or after a full course.
The limitations of this study include small sample size, retrospective data collection, absence of double-blind controlled design, and inability to control for spontaneous mood episodes in patients with BD.
These results indicate that BD patients treated with isotretinoin for acne are at risk for clinically significant exacerbation of mood symptoms, including suicidal ideation, even with concurrent use of psychiatric medicines for BD. The clinical implications of this study are especially relevant to the treatment of patients with BD because acne usually occurs during adolescence, which is often the age of onset of BD and because a common side effect of lithium (a standard treatment for BD) is acne.
异维 A 酸（Accutane(R)）已用于治疗严重的囊性痤疮约二十五年。已有几例异维 A 酸不良反应的精神科反应报告，包括抑郁症状和自杀。然而，只有三例双相情感障碍（BD）患者在接受异维 A 酸治疗时出现不良精神副作用的病例报告。在这项研究中，评估了一组比以前报告的更大的 BD 患者群体中异维 A 酸的精神副作用。
对 300 名 BD 门诊患者的回顾性图表审查确定了 10 名接受异维 A 酸治疗的患者。
这 10 名患者中有 9 名患者的情绪症状明显恶化，3 名患者出现自杀意念。当异维 A 酸停药时，8 名患者的情绪症状复发得到缓解，无论提前停药还是完成全疗程停药。
本研究的局限性包括样本量小、回顾性数据收集、缺乏双盲对照设计以及无法控制 BD 患者自发的情绪发作。
这些结果表明，接受异维 A 酸治疗痤疮的 BD 患者存在情绪症状显著恶化的风险，包括自杀意念，即使同时使用 BD 的精神药物。本研究的临床意义尤其与 BD 患者的治疗有关，因为痤疮通常发生在青春期，而青春期通常是 BD 的发病年龄，并且锂（BD 的标准治疗）的常见副作用是痤疮。
