Isotretinoin and mental health: what monitoring happens in the UK?
People considering isotretinoin often worry about depression, anxiety or changes in mental health. Acne itself can affect wellbeing, while possible psychiatric side effects have also been reported during and after treatment.
Quick answer
Current UK rules require mental health to be assessed before isotretinoin is prescribed and reviewed throughout treatment. This includes a clinical conversation and a patient-completed questionnaire; a score should never replace clinical judgement. At each follow-up, the prescriber should ask about mood changes, depression, self-harm and suicidal thoughts. Patients should also report concerns between appointments. [1–4]
Having a previous mental health condition does not automatically mean that isotretinoin is unsuitable. It does mean the clinician needs enough information to assess risk, agree appropriate support and decide with you whether the potential benefits outweigh the risks.
Does isotretinoin cause depression?
The relationship is not straightforward. Severe acne is itself associated with psychological distress, low mood and anxiety. A large 2024 meta-analysis found no increased population-level risk of suicide or psychiatric disorders among isotretinoin users. However, population studies cannot rule out a rare individual reaction, and patients have reported mood and behavioural changes. [5]
For that reason, UK regulators do not treat the question as settled by reassuring statistics. The MHRA requires counselling, baseline assessment and ongoing monitoring. The aim is neither to frighten patients nor to dismiss symptoms, but to recognise changes early and respond safely. [1,2]
What happens before treatment starts?
The first assessment should be in person. Under current MHRA and BAD guidance, it should cover:
your current mood and mental wellbeing;
previous depression, anxiety, self-harm, suicidal thoughts, psychosis, aggression or major mood disturbance;
any mental health treatment or medicines;
relevant family psychiatric history;
how acne affects daily life and quality of life; and
recent changes in feelings or behaviour.
Answer openly, including about problems that happened years ago. This information is used to plan safer care, not simply to exclude you from treatment.
You should also complete an objective patient-reported outcome measure, often called a PROM. Examples include PHQ-9 with GAD-7 or GAD-2, HADS, or the Mood and Feelings Questionnaire. An adolescent version of PHQ-9 may be used for younger patients. These tools can highlight symptoms and provide a baseline, but the BAD stresses that none is validated specifically for deciding whether someone with acne should receive isotretinoin. [2]
If concerns arise, the prescriber may seek information from your GP or mental health team, arrange further assessment, strengthen follow-up or discuss an alternative. The decision should be shared with you.
How is mental health monitored during treatment?
The first follow-up is generally recommended around four weeks after starting, although it may be delayed to eight weeks when clinically appropriate. Follow-up does not always have to be face to face, but mental health and other safety requirements still apply. [1,2]
At every review, expect questions about:
low mood, anxiety or unusual irritability;
loss of interest or enjoyment;
sleep, concentration or energy changes;
aggression, impulsive behaviour or feeling unlike yourself; and
thoughts of self-harm or suicide.
Baseline questionnaires should be repeated at least once within the first three months and again if concerns arise. A rising score is a prompt for discussion, not a diagnosis on its own. The clinician should consider the answers alongside your history, circumstances, acne and other medicines. [1,2]
UK monitoring also includes asking about possible sexual-function concerns before and during treatment. Tell the clinician about any new or worsening problem rather than assuming it is unrelated or feeling embarrassed. [1–3]
What should I do if my mood changes?
Do not wait for the next routine appointment. The BAD patient guide advises stopping isotretinoin and contacting the dermatology team if you or someone close to you notices a concerning change in feelings or behaviour. The team can assess whether the medicine should remain stopped and arrange help. [3]
If you have thoughts of harming yourself, feel unable to keep yourself safe, or there are serious concerns about your mental health, stop isotretinoin and seek immediate medical help. Call 999 or go to A&E if there is an immediate risk to life. For urgent mental health help, contact NHS 111 or request an urgent GP appointment. [3,6]
Stopping the medicine is not a substitute for mental health care. Symptoms may have several causes and should be assessed properly.
Can someone with depression take isotretinoin?
Sometimes, after individual assessment. A history of depression or anxiety is not an automatic ban, but the prescriber may want input from another clinician or closer monitoring. Tell the team about medicines, therapy and previous crises; do not stop mental health treatment without advice.
How can family or friends help?
Someone close to you may notice withdrawal, irritability or behaviour changes before you do. Consider telling them what warning signs to watch for. Young people should receive age-appropriate information; parents or carers can support monitoring while privacy and safeguarding still matter.
Putting monitoring in context
Isotretinoin is reserved for severe acne that has not responded adequately to appropriate standard treatment, or acne at risk of permanent scarring. It is not right for everyone. Monitoring also covers physical health, pregnancy prevention where relevant, blood tests, sexual function and other side effects. [1,4]
If acne is persistent, painful, scarring or significantly affecting your wellbeing, a structured assessment can review your previous treatment and suitable next steps. mySkinDoc describes a doctor-led isotretinoin pathway for appropriate patients, with assessment, counselling and ongoing monitoring. You can read about mySkinDoc’s acne and isotretinoin service or arrange a video acne consultation to discuss your situation. The first isotretinoin assessment must be in person, and a consultation does not guarantee that the medicine will be prescribed.
Frequently asked questions
Is a mental health questionnaire enough?
No. It supports the assessment but does not diagnose a condition or decide suitability by itself. A clinical discussion is essential.
Will previous anxiety or depression rule me out?
Not automatically. The prescriber should assess your history, current wellbeing, support and treatment, then discuss the balance of benefits and risks with you.
Can follow-up be online?
Yes, when clinically appropriate. Current UK guidance allows remote follow-up, but the initial assessment must be in person and the same safety monitoring is still required.
Who can report a suspected side effect?
Patients, relatives and healthcare professionals can report suspected side effects through the MHRA Yellow Card scheme. You should still contact the treating team or urgent services as appropriate. [7]
References
Medicines and Healthcare products Regulatory Agency. Isotretinoin: changes to prescribing guidance and additional risk-minimisation measures. Published 22 January 2026.
British Association of Dermatologists. Isotretinoin FAQs: assessment and monitoring.
British Association of Dermatologists. Isotretinoin patient guide.
National Institute for Health and Care Excellence. Acne vulgaris: management (NG198).
Tan NKW, et al. Risk of suicide and psychiatric disorders among isotretinoin users: a meta-analysis. JAMA Dermatology. 2024;160(1):54–62.
MHRA. Yellow Card reporting.
Sources and service details checked 10 October 2026.
