***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: Despite many years of clinical use of isotretinoin , a comprehensive review of evidence for isotretinoin therapy in patients with acne is lacking . We search ed MEDLINE , Embase , Cochrane Central , relevant web pages and bibliographies for r and omized controlled trials in acne evaluating isotretinoin vs. control ( placebo or other therapy ) . Data were extracted and summarized descriptively . Eleven trials were identified ( total 760 patients r and omized ) , containing mostly men . Mean treatment ages ranged from 18 to 47·9 years and participants generally had moderate‐to‐severe acne . Across all trials , isotretinoin therapy reduced acne lesion counts by a clinical ly relevant amount , and always by a greater amount than control , which was either placebo ( two studies ) , oral antibiotics ( seven studies ) or other control ( two studies ) . Across trials with an overall low risk of bias , two of three demonstrated statistically significant differences between isotretinoin and control . The frequency of adverse events was twice as high with isotretinoin ( 751 events ) than with control ( 388 events ) . More than half of all adverse events were dermatological and related to dryness . Adverse events from isotretinoin causing participant withdrawal from trials ( 12 patients ) included Stevens – Johnson syndrome , cheilitis , xerosis , acne flare , photophobia , elevated liver enzymes , decreased appetite , headaches and depressed mood . This review suggests that isotretinoin is effective in reducing acne lesion counts , but adverse events are common . This study was registered with PROSPERO number CRD42015025080 Objective Acne is the most common skin disease and isotretinoin is the most powerful drug among the various drugs used for its treatment , but it has some adverse effects . The aim of this study was to evaluate the effect of isotretinoin on depression and quality of life of a group of patients undergoing isotretinoin therapy before and after the treatment course . Methods In this prospect i ve study , 98 patients with severe acne were enrolled consecutively and underwent isotretinoin therapy receiving 0.5 mg/kg/d of isotretinoin for 16 weeks . Isotretinoin effects on quality of life and depression were evaluated using Dermatology Life Quality Index ( DLQI ) and Beck Depression Inventory ( BDI ) question naires , respectively . Results In this study , 98 patients suffering from severe acne ( 38 males and 60 females ) were enrolled . Treatment of acne was associated with improvement of quality of life scores in both male and female patients ( p = 0.001 ) . Considering the cutoff value of 13 for mild depressive mood in the BDI score , in total , 48 ( 49 % ) of the enrolled patients ( 21 males and 33 females ) had a mild depressive mood before the commencement of the treatment in this study . The analysis of before and after treatment BDI scores showed that the number of patients and also the mean score of BDI were increased in both male and female patients after the treatment ( p<0.05 ) . Conclusion Isotretinoin therapy improved the quality of life of patients suffering from acne , but depression was accentuated in the patients to some extent 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 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 Isotretinoin , a synthetic oral retinoid that is used against severe nodulocystic acne , has been associated with various psychiatric side effects such as depression , suicidality and psychotic symptoms . A great number of reports on its effects have been published since its introduction into the market . However , a causal relationship has not been established and the link between isotretinoin use and psychiatric events remains controversial . The present paper review s the available evidence regarding the association of isotretinoin and psychiatric side effects . All published material reporting psychiatric side effects following isotretinoin treatment , including case reports , case series , reports from adverse drug event reporting systems , prospect i ve surveys and retrospective case-control studies , are presented . In addition , the neurobiology of the retinoids and possible biological mechanisms that may lead to psychopathology are described 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 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 isotretinoin . OBJECTIVE This study investigated the impact of isotretinoin use for patients with acne on mood status .  The hypothesis was that an association exists between the use of isotretinoin and the development of depression , aside from acne severity . METHODS We studied the relationship between isotretinoin and depression using a prospect i ve , controlled , cohort design . The study was conducted in a community dermatology clinic . The exposed cohort consisted of consenting patients who were initiating isotretinoin treatment for acne . Patients were either treated with isotretinoin ( Acutaneï ) therapy ( study group ) ( N=100 ) or by oral ( N=41 ) or topical acne therapy ( control group ) ( N=59 ) . The Center for Epidemiologic Studies Depression scale and the Zung Depression Status Inventory were used to assess depression both at baseline and after 2 months of prescribed use of isotretinoin or a control medication ( topical or oral antibiotics ) . RESULTS There was no correlation between isotretinoin use and the development of depression , based on either the Centre for Epidemiologic Studies Depression scale ( Fisherâs exact test , P=0.497 ) or Zung Depression Status Inventory ( ANOVA ; F=1.4 , P=0.2 ) . CONCLUSION Isotretinoin does not appear to be associated with the development of depression . Thus , denying patients with significant acne an effective medication for fear of developing depression may not be indicated at this point in time BACKGROUND Since the introduction of isotretinoin to the market , many adverse psychiatric effects , including depression , anxiety and suicide attempts were reported . The aim of this study was to determine whether patients with acne who were treated with isotretinoin experienced significant increases in psychiatric symptoms over a 4-month period compared with patients who received topical acne therapy . METHODS Seventy-eight acne patients were allocated either to isotretinoin treatment ( study group ) ( n = 37 ) or to topical treatment ( control group ) ( n = 41 ) . Their psychological status was evaluated at the baseline , second and fourth months of the treatment . All patients were required to complete the dermatology life quality index ( DLQI ) , the Hospital anxiety and depression ( HAD ) scale , and the beck depression inventory ( BDI ) . RESULTS The two groups were not different from each other in terms of DLQI , BDI , HAD-A , HAD-D and total HAD scores at baseline . However , at the end of the second month quality of life was more impaired in the topical treatment group compared to the isotretinoin group ( P < 0.05 ) , and there were no difference between two groups in terms of BDI , HAD-A , HAD-D , and total HAD scores ( P > 0.05 ) . At the end of fourth month quality of life and all psychological test scores had improved more in the isotretinoin group compared to topical treatment group ( P < 0.05 ) . CONCLUSION Results of the present study indicate that there is no increase in depress 
    Output:
    
This study suggested an association of the use of isotretinoin in patients with acne with significantly improved depression symptoms .