I have been working with a dermatologist on my acne for about the last 8 years and have tried just about everything aside from Accutane. My dermatologist has recently made the strong recommendation that I finally try Accutane. Because I have a history of depression, I had to go through additional screening including a psych evaluation. My dermatologist has suggested that the risk of increased depression from the medication is not that likely. When I asked the psychiatrist about the link between Accutane and depression, he suggested that it was settled science that Accutane partially shuts down a portion of the brain that is responsible for dopamine production. But that it will likely come back online after I am done taking the medication. As far as I can tell the body of evidence on Accutane and depression does not suggest a strong link between the two. (Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis - PubMed)
Should I be worried about an increase in depression and is there any way to undo what feels like a very large nocebo from my psych evaluation. Apologizes for the long-winded question.
Depression is not as simple as a single area of the brain’s dopamine production, so I would not pay that specific comment weigh on you too heavily. I agree that the body of evidence does not clearly implicate Accutane as having a causal relationship here. The topic remains controversial and unclear; in some folks, severe untreated acne may itself have more harmful psychosocial effects than the medicine. Obviously I cannot weigh these different potential risks and potential benefits for you, but this is hopefully how your doctors are approaching the question.