Sleep

Evaluation of Depression, Anxiety, and Sleep Quality in Patients With Acne Vulgaris Receiving Isotretinoin Treatment.

Celik C & Celik M • Human psychopharmacology • 2026

TL;DR

Isotretinoin treatment was associated with a significant reduction in acne severity, depression, and anxiety, while a transient increase in depressive and anxiety symptoms was observed during the first month, and no significant overall change in sleep quality was observed.

Key Findings

Results

Isotretinoin treatment was associated with a significant reduction in acne severity over the 3-month follow-up period.

Acne severity was measured using the Global Acne Grading System (GAGS) at baseline, end of month 1, and end of month 3
155 patients receiving isotretinoin treatment at a tertiary dermatology outpatient clinic in Turkey were included
Data were collected between January 2023 and December 2024
The study used a retrospective analysis of prospectively collected data

Results

A transient increase in depressive and anxiety symptoms was observed during the first month of isotretinoin treatment, followed by significant improvement by the third month.

Depression was measured using the Beck Depression Inventory (BDI) at baseline, end of month 1, and end of month 3
Anxiety was measured using the Beck Anxiety Inventory (BAI) at the same time points
The temporary increase in depression and anxiety observed at the end of the first month may be related to the cutaneous side effects of isotretinoin
By the third month, both depressive and anxiety symptoms showed significant improvement compared to baseline

Results

Overall, isotretinoin treatment was not associated with a significant deterioration in sleep quality throughout the study period.

Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) at baseline, end of month 1, and end of month 3
No significant overall change in sleep quality was observed across the 3-month treatment period
Patients with systemic diseases affecting sleep were excluded from the study
Patients with a history of psychiatric disorders or use of psychotropic medications were also excluded

Methods

The study excluded patients with psychiatric histories, psychotropic medication use, or systemic diseases affecting sleep or mood to isolate the effects of isotretinoin.

Exclusion criteria included a history of psychiatric disorders, use of psychotropic medications, and systemic diseases affecting sleep or mood
155 patients were included in the final analysis
The study was conducted at a tertiary dermatology outpatient clinic in Turkey
Assessments were administered at three time points: before treatment, at end of month 1, and at end of month 3

Discussion

The temporary increase in depression and anxiety during the first month of isotretinoin treatment was attributed to cutaneous side effects of the medication.

The authors specifically suggested the first-month increase in neuropsychiatric symptoms may be related to cutaneous side effects of isotretinoin
This finding is offered as a potential explanation for previously reported associations between isotretinoin and psychiatric symptoms
The authors call for further prospective studies to better clarify the neuropsychiatric effects of isotretinoin
The pattern of transient worsening followed by improvement distinguishes the study's findings from studies suggesting persistent psychiatric harm

What This Means

This study followed 155 patients in Turkey who were being treated with isotretinoin (a strong medication for severe acne) over a three-month period. Researchers measured patients' depression levels, anxiety levels, and sleep quality before starting treatment, after one month, and after three months using standardized questionnaires. To ensure cleaner results, they excluded anyone who already had psychiatric conditions or was taking mental health medications. The research found that after one month of treatment, patients showed a temporary increase in both depression and anxiety symptoms, which the authors suggest may be linked to the skin-related side effects of the medication (such as dryness and irritation) that are common early in treatment. However, by the end of the third month, both depression and anxiety had improved significantly compared to before treatment started — likely because the acne itself had substantially cleared up. Sleep quality did not significantly worsen at any point during the study. This research suggests that isotretinoin's reputation for causing psychiatric side effects may be more nuanced than previously thought. The temporary worsening of mood in the first month may reflect the discomfort of early skin side effects rather than a direct drug effect on the brain, and the longer-term picture appears to be one of psychological improvement as acne clears. The authors emphasize that more prospective studies are needed to fully understand isotretinoin's effects on mental health, and that patients should be monitored — particularly during the first month of treatment.

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Citation

Celik C, Celik M. (2026). Evaluation of Depression, Anxiety, and Sleep Quality in Patients With Acne Vulgaris Receiving Isotretinoin Treatment.. Human psychopharmacology. https://doi.org/10.1002/hup.70036

Key Findings

What This Means

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