Isotretinoin (Accutane) and Depression: No Association
Notice bibliographique
Résumé
Source: Jick SS,Kremers HM,Vastlakis-Scaramozza C. Isotretinoin use and risk of depression, psychotic symptoms, suicide, and attempted suicide. Arch Dermatol. 2000;136:1231–1236.To investigate a proposed association between isotretinoin (Accutane) therapy and the risk of depression, psychotic symptoms, suicide, and attempted suicide, the authors analyzed information from the Canadian Saskatchewan Health Database and the United Kingdom General Practice Research Database (GPRD). In the Saskatchewan database, 7195 isotretinoin users and 13,700 antibiotic users aged 10 to 29 years were identified between 1983 and 1996; in the GPRD, 340 isotretinoin and 676 antibiotic users were identified over an unspecified time period. Medical histories for all subjects were available for 6 months to 5 years before and at least 12 months after initiating treatment. Prevalence rates of mental health disorders in acne patients who received isotretinoin were compared to those of acne patients taking antibiotics. In addition, prevalence rates of mental health disorders among patients taking isotretinoin were compared to prevalence rates in those same patients before the start of treatment. The study was funded by Hoffmann-LaRoche, Ltd., Accutane’s manufacturer.Relative risk (RR) estimates for developing depression or psychosis were calculated by comparing current or recent use of isotretinoin or antibiotics with nonexposure (defined as no use of either study drug for more than 6 months). The RR of depression or psychosis among current isotretinoin users was 1.0 (Saskatchewan Health Database) and 1.8 (GPRD) as compared to non-exposed patients. The RR of depression or psychosis among current antibiotic users was 1.3 (Saskatchewan) and 1.5 (GPRD). Compared with pre-treatment, the RR of depression or psychosis among current isotretinoin users was 1.2 (Saskatchewan) and 1.3 (GPRD). Using data from Saskatchewan, the RR for suicide or attempted suicide was 0.9 for current isotretinoin use when compared to nonexposed patients. None of these RRs were statistically significant and, therefore, the authors conclude that there is no evidence that isotretinoin use is associated with an increased risk for depression, suicide or other psychiatric disorders.The possibility that isotretinoin use, through mechanisms unknown, might be associated with an increased risk of mental health disorders (including depression and suicide) has been the subject of some debate1 and media reports, most recently a report on a nationally-televised program.2 Concern about this association led the FDA to include the following warning in the drug’s prescribing information: “Accutane may cause depression, psychosis, and, rarely, suicidal ideation, suicide attempts and suicide. Discontinuation of Accutane therapy may be insufficient; further evaluation may be necessary.”1There seems little doubt that acne may have a significant impact on an adolescent’s emotional well-being. Before treatment, many adolescents with acne experience some psychosocial consequence of their disease that ranges from anxiety or embarrassment to lowered self-esteem, perceived social rejection or depression.3–6 In general, successful treatment with conventional agents (eg, antibiotics) or isotretinoin is associated with reduced anxiety and depression.1,3–7 The results of the present study, conducted using a large population-based sample, do not support an association between isotretinoin use and depression or psychosis. Although the number of completed or attempted suicides was small, these events do not appear to be associated with isotretinoin use. Nonetheless, clinicians caring for patients receiving Accutane should remain alert to the possible coexistence of mental health disorders, including depression.Are the results of this study sufficient to reject the hypothesis that isotretinoin increases the risk of depression? In the court of scientific opinion the evidence would appear sufficient, but what about the court of public opinion or the courts that hear product liability cases? Medicine, law, and the public at large frequently differ about what constitutes a causative link and what criteria should be used in establishing causation. Today, the scientific process by which a hypothesis is tested and then either accepted or rejected has been distorted by the media and internet. The hypothesis that isotretinoin is linked to depression and suicide is deemed worthy of a TV newsmagazine but a well-done epidemiologic study refuting it is not.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».