BY JULIE GABRIEL, June 18, 2012.

Retinoids represent a group of compounds derived from vitamin A, one of the most effective skin-friendly vitamins. Retinoid acne treatment help reduce acne symptoms by suppressing the sebum production. Retinoids also help by normalizing the shedding rate of dead skin cells so that they do not accumulate in the follicle.

Psychological disorders such as depression, anxiety, and body dysmorphic disorder are common in patients with acne, and some of the more extreme cases were linked to the treatment with retinoids. The relationship between oral isotretinoin and depression and suicide has been clearly proven. Isotretinoin (13-cis-retinoic acid), approved by the US Food and Drug Administration for the treatment of acne, carries a black box warning related to the risk of depression, suicide, and psychosis. Retinoids perform a large variety of functions in many systems, in particular the central nervous system, and abnormal retinoid levels can have adverse neurologic effects. Retinoids also influence neurochemical systems that have been implicated in depression, such as dopamine, serotonin and norepinephrine (source).

Isotretinoin in particular is highly teratogenic (causes damage to the unborn child) for the central nervous system as it inhibits certain processes in parts of the brain. Because of its teratogenic effects isotretinoin was originally approved only for severe acne, today however only about 8 percent of patients with severe acne are treated with isotretinoin (Goulden et al 1995).

There is an extremely high risk of birth defects if a woman takes isotretinoin or other retinoids during pregnancy, even if she takes a small amount of the drug for a short period. Birth defects caused by isotretinoin include hydrocephaly (enlargement of the fluid-filled spaces in the brain), microcephaly (small head and brain), mental retardation, ear and eye abnormalities, cleft palate and heart defects. (March of Dimes)

Retinoic acid has many other important functions in the human body. It influences the function of the urogenital system, epithelia of the gut and respiratory tracts, as well as skin, bone and cells of the immune system. Vitamin A is obtained in the diet either from meat in the form of retinyl esters that are hydrolyzed to retinol, or from plants as beta-carotene which can be cleaved to retinaldehyde and then reduced to retinol. Plant sources of vitamin A do not pose any risk for overdose unlike supplements and retinoid topical treatments.

Depression, suicide, psychosis, violence and aggression – are you really worth it? In July 2009, O! Oprah's Magazine called retinoids your "new best skin friend" and listed five reasons why you were not using retinoids but should.  None of these reasons mentioned the depression, anxiety and other psychiatric disorders resulting from the retinoid use.

Retin-A, Differin, Roaccutane and the likes are heavily marketed as the skin cure-all, but make sure you explore other, less dangerous acne medicines before even thinking about trying retinoids. Retinoid treatments are getting well-documented bad rap in the medical literature over the last ten years. But retinoids are a resilient bunch. Men and women are happily using retinol and other retinoid creams for their wrinkles. Could this widespread use of retinoids explain why the depression rates are higher than ever before?

REFERENCES (please contact us for a full list of references)

Hazen PG, Carney JF, Walker AE, Stewart JJ. Depression-a side effect of 13-cis-retinoic acid therapy. Journal of American Academy of Dermatology. 1983;9:278–279.

Cunliff WJ, van der Kerkhof PCM, Caputo R, Caicchini S, Cooper A, Fyrand OL, et al. Roaccutane treatment guidelines: Results of an international survey. Pharmaceutical Treatment. 1997;194:351–357.

Goulden V, Layton AM, Cunliffe WJ. Current indications for isotretinoin as a treatment for acne vulgaris. Pharm Treatment. 1995;190:284–287.

Gupta MA, Gupta AK, Schork NJ, Ellis CN, Voorhees JJ. Psychiatric aspects of the treatment of mild to moderate facial acne: Some preliminary observations. International Journal of Dermatology. 1990;29:719–721.