***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND According to some animal data , impairments in learning and memory are seen with isotretinoin . Isotretinoin has been shown to affect human brain metabolism , but the data on human neural functions is lacking . OBJECTIVES To evaluate whether isotretinoin treatment affects cognitive functions , causes depression and anxiety or alters anger level and anger expression . METHODS Neuropsychological tests of attention and executive functions , behavioural tests measuring anger and depression and measures assessing acne severity were applied to 63 severe and /or resistant acne patients from four medical centres including one primary care institute and three university hospitals at the beginning , at the end of first month , third month and at end of treatment with isotretinoin .  RESULTS From a total of 63 patients , 15 missed the final visit and 48 were evaluated . Overall , 11 ( six women , five men ) and five ( all women ) patients reported anger and depression , respectively , during treatment . Eleven of these 16 patients improved spontaneously . No detrimental effects of isotretinoin treatment on either executive functions or mood were found . Several executive functions and control of anger trait were found to be improved . Clearing of acne was obtained in 94.6 % of patients . LIMITATIONS Improvement of several measures may be related to learning effect of repeated testing . Investigating brain functions is a complex process and various methods can be used . CONCLUSION The test battery used in this study , which is commonly used to evaluate mental status both in adults and children , did not show any negative effect of isotretinoin on executive functional parameters in acne patients We evaluated the psychiatric morbidity and mood characteristics of a group ( n = 72 ) of patients with cystic acne before and after treatment with one of three dosage schedules of isotretinoin .  Although no excess psychiatric morbidity was observed , substantial evidence of psychologic distress was noted before treatment . Significant reductions in anxiety were observed on several measures of anxiety after treatment , with mitigation of anxiety and depression most robust in those patients with the greatest dermatologic improvement with isotretinoin BACKGROUND Patients with cystic acne ( CA ) frequently report feeling self conscious , anxiety and social isolation . METHODS Mood characteristics as well as self-esteem scores of 38 patients with CA were evaluated before and after 30 days treatment with isotretinoin . A high pressure , liquid chromatography method was used for the evaluation of catecholamines ( epinephrine ( E ) and nor-epinephrine ( NE ) ) in the blood of the patients at the time of the study and in controls ( n = 30 ) after their psychological testing . Moreover , E and NE were measured in the blood of eight healthy volunteers before and after 1 month ' treatment ' with the drug . RESULTS The CA subjects evidence d anxiety and high catecholamine plasma levels ( E = 98.0+/-0.8 pg/ml , NE = 250.8+/-56.6 pg/ml ) before treatment compared to controls ( E = 71.8+/-23.0 pg/ml , NE = 190.0+/-52 pg/ml , P < 0.006 ) , and these levels were lower ( E = 75.4+/-21.4 pg/ml , NE = 202.0+/-49.9 pg/ml , P < 0.001 ) when their psychological status returned to normal after treatment . No differences were observed in E and NE levels in the eight healthy volunteers who received the same dose of the drug at the same time of study . CONCLUSIONS It is suggested that not only the psychological status is influenced in subjects with CA but also their sympathoadrenal system BACKGROUND : Isotretinoin therapy and its alleged adverse psychiatric effects have received considerable media attention during the past years . The aim of this pilot study was to investigate whether there was any association between isotretinoin therapy and anxiety , depression or suicidal ideation . METHODS : Forty‐five patients with severe recalcitrant acne were enrolled in this study .  Isotretinoin was administered at a dose of 0.5–1 mg/kg per day in two divided doses with food for 16 weeks . All patients received a complete dermatological examination and the severity levels of their acne were scored according to the Leeds Revised Acne Grading system at baseline ( before isotretinoin treatment ) and follow‐up assessment s at weeks 4 , 8 and 16 of the treatment . Severity of anxiety and depressive symptoms were assessed with the Clinical Anxiety Scale and Montgomery‐Asberg Depression Rating Scale before and upon completion of the 16‐week isotretinoin treatment . RESULTS : Twenty‐three patients completed the final assessment . There was a statistically significant decrease in anxiety scores . Depression scores also decreased but were not statistically significant . No patient committed or attempted suicide . CONCLUSIONS : This pilot study was unable to detect an association between the use of isotretinoin and an increased risk for anxiety , depression , or suicidal thoughts Rationale The acne drug isotretinoin has 13-cis retinoic acid as its active agent . Adverse effects that have been described include severe depression . Animal studies indicate that the hippocampus is particularly sensitive to retinoic acid . Changes induced by isotretinoin to hippocampal function could contribute to depression but may be more evident in altered visuospatial learning and memory , the primary function of the hippocampus . Objectives We aim ed to test the hypothesis that a course of oral isotretinoin therapy would result in declining visuospatial learning and memory . Methods CANTAB tasks design ed to assess visuospatial memory were performed repeatedly on 14 males and 3 females in an open prospect i ve observational study of patients with severe acne undergoing isotretinoin therapy .  Beck ’s Depression Inventory and Global Acne  Grade were also administered . Results Performance stayed unchanged for DMS , SRM and PRM tasks , while surprisingly participants improved their speed on the PRM task . Performance improved across sessions on the PAL task , and moreover the dose of isotretinoin correlated with improvement in the total trial score , reduction in total error rate and stage completed at the first trial . Conclusion Isotretinoin does not reduce learning and memory and our study suggests that it may instead lead to a dose-related improvement in specific aspects of hippocampal learning and memory . Retinoic acid functions in the hippocampus as the active metabolite of vitamin A , suggesting that this may be a limiting factor in the human hippocampus and addition of exogenous retinoic acid brings levels closer to an optimal state Background : Isotretinoin is an effective treatment for severe acne . Although the spectrum of side effects has been well documented , the changing incidence of such side effects over the course of treatment has not been studied in detail . Objectives : The purpose of our study was to examine a group of patients monthly over their course of treatment and prospect ively document the side effects experienced . Methods : Over the period between January 1991 and July 1996 , 124 courses of treatment with isotretinoin for severe acne were followed . The patients were treated for 4 months at a dose of 1 mg per kg body weight . A question naire was administered monthly , inquiring specifically about side effects known to be associated with isotretinoin . Any additional side effects were also noted . Results : The majority of patients experienced persistent dryness of lips . Dry eyes affected 40 % of patients ; this continued throughout treatment in 25 % . Contact lens wearers were more likely to develop conjunctivitis . Lower back pain was reported early in about 30 % of patients and fewer than 10 % of patients would develop it later in the course of treatment . Arthralgia was noted in 16.5 % of patients at the first visit and there was little change with ongoing treatment . Hair loss was experienced in a small percentage but was rarely noted on more than one occasion . Headaches occurred in less than 10 % and were occasionally severe , but most often intermittent and recorded at a single visit . Depression occurred in 4 % of patients and tended to persist throughout the treatment . All these patients completed the full course of treatment . Conclusion : This prospect i ve analysis has shown that patients treated with isotretinoin  experienced a predictable series of side effects . Some occurred fleetingly , but several persisted for the duration of treatment BACKGROUND Depression and mood changes appear as potentional side effects of isotretinoin in the Summary of Product Characteristics . There have been many studies treating this topic but in most cases not identifying any significant depression or suicide risk . To further investigate this issue , we conducted a prospect i ve , uncontrolled study to evaluate mood changes and suicidal ideations in patients receiving isotretinoin therapy .  METHODS One-hundred patients were included in our single center , no-blind , and no controlled prospect i ve study . All patients completed the Beck 's Depression Inventory , Version II ( BDI-II ) before the treatment , following the first month of the treatment and then every third month until finishing the isotretinoin therapy . All question naires were checked by a psychiatrist . Suicidal ideations were monitored . Statistical analysis of BDI-II scores was performed . RESULTS All patients completed the study . Before the treatment , six percent of the patients had suffered from depressive symptoms . During the isotretinoin treatment , we did not find any deterioration of depression problems in any of these patients . On the contrary , in most patients the depressive symptoms disappeared . Symptoms of depression occurred in two patients , in which case coexisting situational factors were found to be the cause . No occurrence of suicidal ideations was found . CONCLUSIONS We did not find any depressive symptoms or suicide risk caused by isotretinoin . On the contrary , a statistically significant improvement of BDI-II scores was found . In our opinion , patients have to be informed about the risk of depression but emphasizing the fact that it is very rare Background : There have been concerns about the association between isotretinoin therapy and depressive symptoms . Objective : The objective of this study is to evaluate whether there is an association between isotretinoin therapy and the onset of depression . Methods : A total of 50 patients with moderate to severe recalcitrant acne and 30 healthy volunteer people were enrolled in the study .  Depressive symptoms and anxiety status were assessed at baseline and then 1 and 4 months after the initiation of isotretinoin treatment . Results : We detected improvement in Beck Depression Inventory ( BDI ) and State and Trait Anxiety Inventory ( STAI ) scores in acne patients after isotretinoin therapy . Statistically significant improvement in depressive symptoms began at the first month . Improvement in anxiety was detected later than the improvement in depressive symptoms and a statistically significant difference was detected between the first and the second follow-up . Conclusions : Our results provide no relationship between isotretinoin use and depression in acne patients BACKGROUND Isotretinoin-Lidose , the first new formulation of isotretinoin in 30 years , differs from previously approved isotretinoin formulations in that it is less dependent on the presence of fat in the gut for absorption . OBJECTIVE Evaluate the safety profiles of isotretinoin-Lidose and food-dependent generic isotretinoin in the largest clinical study with  isotretinoin-925 r and omized patients from 49 study sites . Determine if the efficacy of this new formulation is noninferior to an existing isotretinoin . METHODS Multicenter , double-blind , r and omized , parallel-group , noninferiority trial . Study medication was taken with meals twice daily for 20 weeks . Patients were followed for 4 weeks after the last dose . Safety evaluations included recordings of adverse events , assessment s for depression , anxiety , emergent psychotic symptoms , and suicidal ideation/behavior , as well as DEXA and X-ray evaluations and changes in bone age . Two co- primary efficacy outcomes were measured to assess noninferiority : a ) change in total nodular facial and truncal lesion count at from baseline to week 20 and b ) percentage of patients who experienced at least 90 % reduction in nodular facial and truncal lesion count from baseline to week 20 . LIMITATIONS Although isotretinoin-Lidose can be taken without meals , it was given with food because the absorption of both formulations in the study had to be similar to detect noninferiority . RESULTS The safety profile of the 2 formulations was comparable . Criteria for noninferiority for both co- primary efficacy outcomes were met based on predetermined margins . CONCLUSION Safety and efficacy of isotretinoin-Lidose is similar and noninferior to food-dependent generic isotretinoin , respectively There have been recent concerns about the possible association between isotretinoin therapy and depressive symptoms . We conducted a prospect i ve study to evaluate depressive symptoms and quality of life in acne patients having either isotretinoin or antibiotics/topical treatments .  There were 215 patients ( mean age 20 years ) included in the study .  Depression , quality of life and acne severity ratings were administered at baseline , 1 month , 3 months and end of treatment or 6 months , and compared between both treatment groups . The changes in the mean depression scores did not differ significantly between both groups ( P = 0.62 ) . The incidence of isotretinoin patients with moderate depressive symptoms remained relatively unchanged from baseline . The changes in the quality ‐of‐life measures scores between treatment groups showed no significant difference . No correlation between isotretinoin dose and depression score was found . Although five isotretinoin patients were withdrawn during the study because of worsening of mood , no definite causal relationship was established . This pilot study does not appear to support any direct link between depression and isotretinoin , apart from being a rare unpredictable idiosyncratic side‐effect . However , because of the study limitations , a larger study is needed to confirm the findings BACKGROUND There has been concern that the use of isotretinoin to treat acne may lead to depression . To date , research has not conclusively determined if this concern is warranted when contemplating the use of isot 
    Output:
    
Conclusions Isotretinoin treatment for acne does not appear to be associated with an increased risk for depression .
Moreover , the treatment of acne appears to ameliorate depressive symptoms