Does Accutane (isotretinoin) cause mood changes? | Dermatologist explains in 6 minutes

[@nadashaban908]

Thank you doctor for sharing your knowledge and clinical tips with younger doctors , we really appreciate it ❤️

[@DrJohnBarbieri]

Glad you found it helpful! Please make sure to share the video with your colleagues.

[@laurenblack9787]

Thank you for sharing your knowledge! I started accutane treatment a week ago and have been nervous about this association, especially with mental health history. I also watched another one of your videos about reducing side effects and have taken your advice in taking an omega 3 supplement daily to reduce dryness. It’s probably too early to tell but so far I haven’t really gotten too dry. Do you have any specific advice on what kind of skincare routine or products I could or should be using to really enhance the process or results of accutane? Especially as someone who is purging a bit?

[@DrJohnBarbieri]

Glad that you are finding the videos helpful! For patients I am seeing on isotretinoin, I typically recommend only using a gentle cleanser, sunscreen (as isotretinoin makes people more sensitive to the sun), and moisturizer.

[@ramiefathy]

Are there any risk factors for the development of mood symptoms while on isotretinoin? Anything we could use to predict who is at higher risk? Does a history of depressive symptoms increase risk, as the textbooks suggest? Or are the case reports more sporadic and lacking a unifying risk factor?

[@DrJohnBarbieri]

The appear to be sporadic. I think there is some dose dependency, anecdotally. I would suggest those with depression related to acne might in fact be the most likely to benefit.

[@no_prisoners6474]

I’m in the middle of low mood and just emptiness experience. I’m on antidepressants so maybe that’s why I’m still alive, but my adhd meds have lost effect entirely.

[@Levi-bs4oe]

Is there anything to can do to prevent an overly dry scalp. I am currently using a leave-in conditioner, hair oil, gentle shampoo, and a prescription ketoconazole shampoo; however, I am still met with dandruff and itchy mess as a result of Isotretinoin.

[@DrJohnBarbieri]

Omega-3 seem to be a good strategy to prevent any kind of dryness from isotretinoin. However, dry and flaky scalp can have a variety of causes. Some of these, like eczema or contact dermatitis, might be worsened by isotretinoin. Others, like seborrheic dermatitis, sometimes improve with isotretinoin. When it comes to treating any skin problem, it is important to have the right diagnosis and seeing a dermatologist can be a good first step.

[@stephaniecox-pl3zz]

thank you for this video ! can you take Cabtreo while taking doxycycline?

[@DrJohnBarbieri]

It is recommended to use topical benzoyl peroxide and other topical medications when using oral antibiotics, so Cabtreo (which has benzoyl peroxide) would often be a good option to combine with oral antibiotics (often with the goal of eventually trying to get off the oral antibiotic).

[@emilyparker313]

Love accutane, definitely a power house. What do you think about combining low dose accutane + (topical adapalene 3 times per week)?

[@DrJohnBarbieri]

I think it does not make much sense to combine oral and topical retinoids. The goal of oral isotretinoin is typically to induce a long-term remission. Since we typically try to treat to clinical endpoints (e.g. clear x2-3 months), having other topical treatments makes this more difficult to evaluate and is more work for the patient. The topical retinoid can also increase issues with dryness. However, mild topical retinoids like adapalene can be a good maintenance treatment for those after isotretinoin.

[@no_prisoners6474]

I had moderate acne and texture that really got on my nerves and I didn’t feel ‘clean’ Skin looks airbrushed now from 2 months of using oratane 20mg twice daily. However, right now I am feeling lonely and empty. I’m on medication for ADHD and depression. Notably the adhd medication has had ZERO effect in the past month. I guess the antidepressants are helpful in that I haven’t lost the will to live but I definitely feel the mental health downsides on oratane.

[@DrJohnBarbieri]

Thank you for sharing your experience. Please make sure to discuss these symptoms with your doctors.

[@JohnDoe-nq8bo]

So if I understood correctly, the depression symptoms that may come with istretinoin are reversibles ? Like you said people take accutane, they get depressed, they stopped taking accutane, the depressive symptoms go away ? And my research on this side effect shown that it is very rare (like 1 in a 1000) am I right on this point ?

[@DrJohnBarbieri]

The strongest evidence to suggest isotretinoin can cause mood changes also supports that these effects are temporary (challenge-challenge case series). Serious mood side effects seem to be extremely rare (though more mild mood effects like irritability might be more common). A key thing to keep in mind is that repeatedly cohort studies support that on average mood is improved with isotretinoin compared to other acne treatments (likely because acne itself can cause serious effects on mental health and isotretinoin is by far the most effective acne treatment).

[@JohnDoe-nq8bo]

@@DrJohnBarbieri Thanks for your answer Dr

[@michaelblue4619]

@@DrJohnBarbieri according to the studies you quoted, I'm afraid that accutane will cause irreversible damage to the brain as it stated it affected the brain and hippocampus, what are your thoughts on this?

[@Macorelppa]

This channel will blowup in next 2 years just start responding to tik tok skin care videos.

[@DrJohnBarbieri]

Glad you have found the content interesting!

[@ritikagc7546]

Hello Doctor..It's been 10 months since I stopped taking accutane. I still have face flushing. Why?

[@DrJohnBarbieri]

In general, isotretinoin does not treat flushing. I have some other videos on managing redness/flushing in rosacea.

[@AsusZenfone-kz3fc]

I’m sorry to say but you will probably get scars, can you share me that you got scars or not?

[@dennisguilder1]

What are your thoughts on using fabior foam .1% for KPRF (keratosis Pilaris rubra faceii) instead of using Tazarotene gel or cream? Also this condition is tough to treat and seen literature if applying retinoids twice daily for severe acne scars like adapelene and they had better outcomes than once daily. Makes you wonder if applying twice daily could be better

[@DrJohnBarbieri]

Very hard to treat. When using retinoids, I prefer tazarotene lotion to other formulations as it has the strongest data the vehicle helps reduce irritation.

[@dennisguilder1]

@@DrJohnBarbieri what are your thoughts on using Tazarotene twice daily for kprf to exfoliate skin more than once daily in that specific use case? I was using Tazarotene gel and now using fabior foam. Also thank you for reply!

[@dennisguilder1]

@@DrJohnBarbieri can you do a video on kprf and your thoughts? Retinoids don’t help it much but I seen a study about topical sirolimus 1% cream applied TWICE daily for it. Also wonder about for bodily KP if just get pulse dye laser when everything else in existence fails.

[@xchoops]

Very helpful!

[@DrJohnBarbieri]

Glad you think so!

[@davidsalve9648]

Can topical retinol help with acne with the same effect as isotretinoin?, is topical retinol a good alternative to isotretinoin?

[@DrJohnBarbieri]

Isotretinoin is substantially more effective than topical treatments such as topical retinoids/retinol. However, for mild-to-moderate acne, a good multimodal topical regimen can often be effective (check out other videos on the channel for more about topical acne treatments).

[@alexleee3885]

Hello, doctor. I'm currently on a low dose of Accutane, 10mg per day, starting my fifth month. Despite being on Accutane, I still get those annoying whiteheads/pustules. I had some azelaic acid left, so I started using it for its antibacterial effect, and it totally cleared up. However, it is drying, and sometimes it's hard to tolerate both, but without azelaic acid everuting comes back. As an acne expert, what's your opinion on my situation?

[@DrJohnBarbieri]

Unfortunately, I cannot provide medical advice or speak to your specific situation. Most patients do need at least 120-150mg/kg of isotretinoin to achieve clear skin, so low dose regimens often take longer than higher dose regimens.

[@NMat2]

can tretinoin give similar effects to accutane?

[@DrJohnBarbieri]

No, while a very good acne treatment, it is much less effective than oral isotretinoin (Accutane).

[@NMat2]

@@DrJohnBarbieri my acne is very mild. My doctor gave me 10mg 3 days a week for 2-3 months. But idk if its the pill but i have been feeling more down and “depressed” these past months and i noticed my body hurts much more after working out

[@AsusZenfone-kz3fc]

Does isotretinoin cause increased dandruff?

[@DrJohnBarbieri]

Since it can decrease oil production, isotretinoin can be used as a treatment for severe seborrheic dermatitis (dandruff), so usually it does not make it worse. However, it can cause general dry skin, which could cause more scaling on the scalp.

[@AsusZenfone-kz3fc]

@ 👍👍

[@isabelwall1714]

I struggle with depression, am I guaranteed to experience, worsened, depression, or anxiety?

[@DrJohnBarbieri]

I can't speak to your specific situation, but on average people who are treated with isotretinoin experience improvements in depressive symptoms compared to those treated with other acne treatments. However, isotretinoin can rarely, and unpredictably, cause worsened mood or other mood changes.