Objective

Although patients with acne carry an increased risk of developing major depressive disorder (MDD), the association between acne treatments and depression remains unclear. In particular, no adequate evidence exists to support the relationship between isotretinoin and depression. The objective of this study is to examine the association between acne drugs, especially isotretinoin, and the development of MDD among acne patients.

Methods

The 2007-2011 MarketScan™ Medicaid Multi-State Database was analyzed for this retrospective cohort study. Individuals of any age who were diagnosed with acne and treated with acne drugs were included in our study. This study utilized the Cox Proportional-Hazard (PH) survival model with robust variance estimation to estimate the hazard of developing MDD for patients receiving acne pharmacological treatments.

Results

The likelihood of MDD occurrence in patients with acne varied with age, gender, race, physician specialty, and types of acne drugs received. Patients who used antibiotics (oral and topical), topical glucocorticoid, or oral isotretinoin were significantly less likely to have MDD compared to those who did not use these drugs. In particular, we found a dose-response relationship between isotretinoin and the development of MDD. The higher the cumulative dose of isotretinoin received, the lower the hazard that the patient would be diagnosed with MDD during the study period.

Conclusion

This study suggests that successful management of acne could prevent the onset of MDD.