Bremner J Douglas
Department of Psychiatry & Behavioral Sciences, and Department of Radiology and Imaging Sciences, Emory University School of Medicine, VA Medical Center, Decatur, GA, United States.
J Affect Disord Rep. 2021 Dec;6. doi: 10.1016/j.jadr.2021.100230. Epub 2021 Sep 10.
Isotretinoin (13-cis-retinoic acid, marketed under the names Accutane, Roaccutane, and others) is an effective treatment for acne that has been on the market for over 30 years, although reports of neuropsychiatric side effects continue to be reported. Isotretinoin is an isomer of the active form of Vitamin A, 13-trans-retinoic acid, which has known psychiatric side effects when given in excessive doses, and is part of the family of compounds called retinoids, which have multiple functions in the central nervous system.
The literature was reviewed in pubmed and psychinfo for research related to isotretinoin and neuropsychiatric side effects including depression, suicidal thoughts, suicide, mania, anxiety, impulsivity, emotional lability, violence, aggression, and psychosis.
Multiple case series have shown that successful treatment of acne with isotretinoin results in improvements in measures of quality of life and self esteem However, studies show individual cases of clinically significant depression and other neuropsychiatric events that, although not common, are persistent in the literature. Since the original cases of depression were reported to the United States Food and Drug Administration, numerous cases have been reported to regulatory agencies in the United Kingdom, France, Ireland, Denmark, Australia, Canada, and other countries, making isotretinoin one of the top five medications in the world associated with depression and other neuropsychiatric side effects. Clinicians are advised to warn patients of the risks of neuropsychiatric side effects with isotretinoin which may arise from the medication itself, and not just as a side effect of acne or youth.
异维A酸（13 - 顺式维甲酸，商品名有Accutane、Roaccutane等）是一种治疗痤疮的有效药物，已上市30多年，尽管仍不断有神经精神方面副作用的报告。异维A酸是维生素A的活性形式13 - 反式维甲酸的异构体，13 - 反式维甲酸过量使用时已知有精神方面的副作用，它属于被称为类视黄醇的化合物家族，在中枢神经系统中有多种功能。
在PubMed和PsychInfo中检索与异维A酸和神经精神方面副作用相关的研究文献，这些副作用包括抑郁、自杀念头、自杀、躁狂、焦虑、冲动、情绪不稳定、暴力、攻击行为和精神病。
多个病例系列研究表明，异维A酸成功治疗痤疮可改善生活质量和自尊水平的指标。然而，研究显示存在个别具有临床意义的抑郁及其他神经精神事件病例，尽管并不常见，但在文献中持续有报道。自从最初的抑郁病例报告给美国食品药品监督管理局以来，英国、法国、爱尔兰、丹麦、澳大利亚、加拿大及其他国家的监管机构也报告了大量病例，这使得异维A酸成为世界上与抑郁及其他神经精神方面副作用相关的五大药物之一。建议临床医生告知患者异维A酸可能产生神经精神方面副作用的风险，这些风险可能源于药物本身，而不仅仅是痤疮或年轻的副作用。
