Isotretinoin and suicidal thoughts: warnings

If you’re taking isotretinoin, or took it in the past, and you’re having thoughts of ending your life, please talk to someone today. In the UK and Ireland, call Samaritans free on 116 123, day or night. If you’re not sure what you need, call NHS 111. In an emergency, call 999.

Isotretinoin (Accutane, sold in the UK as Roaccutane) has carried UK warnings about suicidal thoughts since 2003. Its April 2026 UK leaflet warns that mood effects may not end after stopping, and low mood that lasts is part of post-Accutane syndrome, or PAS.

PAS is more than sexual problems. The doctors who proposed criteria for it in 2022 say the name just as often seems to include suicidality and other “cognitive effects” without sexual difficulties. The NHS page on isotretinoin tells you to call 111 if you have thoughts of harming yourself while taking it. It doesn’t say that changes in mood can continue once the course is over.

In late 2020 the UK’s medicines regulator asked the public to tell it about isotretinoin. One person who wrote in was clear about the benefit. “Isotretinoin is incredibly effective so I think the risks can be worth it,” they said. But patients “need to be more informed about the risks”, they added, and “monitoring should be closer”.

Does isotretinoin carry a suicide warning?

Yes. The UK leaflet, last revised in April 2026, lists it under mental problems: “Some people have had thoughts about hurting themselves or ending their own lives (suicidal thoughts).” The same entry also lists “attempted suicide” and “suicide”.

The entry adds: “These people may not appear to be depressed.” The leaflet also asks you to tell friends and family you’re taking it. You may not notice some changes in your mood and behaviour, it says, and they may.

In the US, the Medication Guide for Absorica, an isotretinoin brand, revised in August 2026, uses almost the same words for suicidal thoughts.

If you’re struggling now, the Samaritans are on 116 123, free, at any hour. If calling feels daunting, this one-minute film shows what happens when you do.

Play video: What happens when you call Samaritans?

How long has Accutane warned about suicidal thoughts?

In the UK, for more than 20 years. In August 2003 the UK’s medicines safety committee proposed adding suicidal thoughts and mood changes to the warnings, and European regulators agreed. A review in 2014 added the advice to tell family and friends.

The wording on how often has changed. A March 2022 leaflet put suicidal thoughts under “very rare”. In April 2023 the UK’s expert review said the warnings would be revised “to reflect the unknown frequency”. The April 2026 leaflet says how often “cannot be estimated from available data”.

The checks changed too. Since October 2023, prescribers are asked to assess your mental health before you start and at each follow-up, and every patient signs a risk form. Some rules were eased in January 2026, mostly for under-18s. The mental health warnings are still in the leaflet.

Can mood changes last after stopping Accutane?

For some people they seem to. If your doctor stops isotretinoin, the UK leaflet warns, “That may not be enough to stop the effects: you may need more help, and your doctor can arrange this.” The US label, revised in August 2026, says stopping “may be insufficient”.

The UK’s 2023 review heard of mental health effects that were long term for some people. It said the data could not explain why some people are affected and others are not. In the review and the April 2026 leaflet, we found no figure for how often effects last, or whether they ease (checked October 2026).

Joseph took isotretinoin at 13. His anxiety and panic attacks began months after his course ended, and for years doctors told him the medicine couldn’t be responsible. He says things have improved with time and support, though he’s clear it isn’t a cure.

We cover lasting low mood in more depth in Accutane and depression after stopping.

What can I do?

Isotretinoin helps many people with severe acne. What to do about your treatment is a decision for you and your prescriber. During a course, the UK leaflet asks you to contact your doctor straight away if you notice signs of mental problems.

If low mood has stayed since your course ended, tell your GP and give your dates: “Isotretinoin 30 mg a day from January 2025, last capsule July 2025. Low mood since May 2025, still there now.”

If thoughts of ending your life come with it, ask for an emergency appointment, or call Samaritans on 116 123. Our page on suicidal thoughts with PSSD, PFS or PAS lists more free lines and what to say.

Report it: it helps everyone

A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.

• No proof needed. A suspicion is enough, even years after stopping.
• Mood counts too. You can report low mood and suicidal thoughts, as well as other symptoms.
• Where: the Yellow Card scheme in the UK, MedWatch in the US.
• Use the right words. PAS has no medical term yet, so name each symptom and say it continued after you stopped isotretinoin.

Our reporting guide walks you through it

What else do people ask?

Does Accutane cause suicidal thoughts? The UK’s 2023 expert review said the data could not establish a causal link. A 2024 analysis of 25 studies saw no raised risk of mental health conditions on average. The review said averages may hide people: when mood improves for some, harm in others can vanish from the figures.

What if I’m worried about someone taking it? The leaflet asks patients to tell family and friends because you may spot changes first. The NHS suggests getting them talking and taking what they say seriously. You can call Samaritans for advice about someone else, too.

Will I have to sign anything in the UK? Yes. Since October 2023 every patient is given a risk form to read and sign before starting. It covers mental health and sexual side effects. You can read the current form at home first.

The person who wrote to the UK review asked for closer monitoring. The April 2026 leaflet says: “Your doctor will discuss how best to monitor your mental health during your treatment.” If your mood has changed, tell someone today. If it’s thoughts of ending your life, call Samaritans free on 116 123.

Sources

1. Roaccutane 10 mg and 20 mg soft capsules, patient leaflet, EMC 100633, last revised April 2026. Section 2, “Warnings and precautions”: “Your doctor will discuss how best to monitor your mental health during your treatment.” Section 2, “Mental health problems”: you may not notice changes in your mood and behaviour, so tell friends and family. Section 4, “Mental problems”, frequency not known (“frequency cannot be estimated from available data”). The entry reads: “Some people have had thoughts about hurting themselves or ending their own lives (suicidal thoughts), have tried to end their own lives (attempted suicide), or have ended their lives (suicide). These people may not appear to be depressed.” Then: “Contact your doctor straight away if you get signs of any of these mental problems.” And: “That may not be enough to stop the effects: you may need more help, and your doctor can arrange this.”
2. Commission on Human Medicines, Report of the Isotretinoin Expert Working Group, 26 April 2023, published by the MHRA. Executive summary: data limits “prevented the establishment of causal associations”. The psychiatric warnings “will be revised to reflect the unknown frequency with which these may occur”. Patients should have a mental health assessment before treatment and be monitored during it. Section 1.1.4 reproduces the UK leaflet of March 2022, with suicidal thoughts under “Very rare effects”. Section 1.1.6: in August 2003 the Committee on Safety of Medicines proposed adding suicidal ideation, aggravated depression and mood alteration to the warnings. This was agreed at European level for all oral isotretinoin products. A 2005 review found these warnings adequate. A 2014 review could not establish a causal link, but supported the warnings and the advice to tell family and friends. Section 2.2: the public call for information ran from 10 November 2020 to 16 February 2021. Section 4.1: the quoted comment. Section 4.6: the data do not explain why the risk appears raised in some patients and not others; population studies may not show a raised risk because mood improves for some; psychiatric side effects “some of which were long term”.
3. MHRA, Isotretinoin (Roaccutane): introduction of new safety measures, Drug Safety Update, 31 October 2023. Assessment of mental health before starting and monitoring at each follow-up, including patient-reported outcome measures; the Acknowledgement of Risk Form for all patients. The post-publication note of November 2025 points to the MHRA’s later review.
4. MHRA, public assessment report reviewing how the 2023 measures worked in practice, published 22 January 2026. The requirement for a second prescriber for under-18s was removed, follow-up consultations may be remote where appropriate, and the risk form was streamlined. Current Acknowledgement of Risk Form, January 2026.
5. Absorica and Absorica LD (isotretinoin), US prescribing information and Medication Guide, revised August 2026, DailyMed, US National Library of Medicine. Section 5.4, Psychiatric Disorders: may cause depression, psychosis and, rarely, suicidal ideation, suicide attempts and suicide. Prescribers assess patients before and at each visit during treatment. “Discontinuation of ABSORICA/ABSORICA LD may be insufficient; further evaluation may be necessary such as a referral to a mental healthcare professional”. Medication Guide, “Serious mental health problems”: “Some patients taking ABSORICA or ABSORICA LD have had thoughts about hurting themselves or putting an end to their own lives (suicidal thoughts).”
6. NHS, Isotretinoin (Roaccutane), page last reviewed 26 June 2026. Serious side effects include “thoughts of suicide or self-harm”; call NHS 111 if “you’re having thoughts about harming yourself”. Nothing on mood changes continuing after stopping.
7. Tan NKW, Tang A, MacAlevey NCYL and colleagues. Risk of suicide and psychiatric disorders among isotretinoin users: a meta-analysis. JAMA Dermatol 2024;160(1):54-62. 25 studies in the review, 24 in the meta-analysis. No raised risk of psychiatric disorders overall, “at a population level”.
8. Joseph’s story on our site: Joseph’s story: isotretinoin at 13, from his interview with Moral Medicine, 17 November 2025.
9. Samaritans, Contact a Samaritan: 116 123 is free from any phone, day or night, across the UK and Ireland. NHS, Help for suicidal thoughts: NHS 111, an emergency GP appointment, and 999 or A&E if your life is in danger; the helplines also give advice if you’re worried about someone else, and listening and taking it seriously can help. Page last reviewed 26 April 2024.
10. Samaritans, What happens when you call Samaritans?, 14 July 2023.
11. Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. The term PAS “often refers to what is termed PRSD here but equally often appears to include suicidality and other cognitive effects without sexual difficulties”.