Would you be comfortable using isotretinoin in a female teenage patient who has a history of depression that is now stable but with a prior suicide attempt two years ago?

Yes. There is ample evidence that isotretinoin does not cause depression. In the large Canadian study, there was a slightly negative association with suicide. As the good doctors noted above, using appropriate step therapy, with informed consent (especially regarding pregnancy and birth defects), is...

I have treated several patients who have depression and explained to them and their families that studies have demonstrated that isotretinoin doesn’t cause depression. Cystic acne has been associated with depression.

I make it clear and ask about mood issues and if they are worsening we can stop the...

Likely, yes, but it depends on family support, supervision, and her ability and willingness to report her mental health and suicidal symptoms.

Yes, assuming she failed spironolactone (off-label) and was getting therapy, parents involved, etc.

With proper monitoring, therapy, psych meds, informed consent, and dermatology follow-up, the benefits may outweigh the risks. Much more accepted treatment in mainstream medicine and psychiatry.

I only had one patient who went on it. I communicated with the dermatologist, who felt it would be helpful. She did have a relapse of her depressive symptoms, so we took her off, and the depression resolved. It was clearly related to the medication. But as long as one has a good working relationship...

I think default follow-ups and communication with family, dermatologist, and therapist would provide a sufficient safety net for the patient and the provider…