Abstract

Objective: This study aimed to determine the prevalence of depression and anxiety among isotretinoin users and also to identify its independent risk factors among this population in Riyadh, Saudi Arabia.
Methods: A cross-sectional observational study was conducted among 207 randomly selected isotretinoin users in Riyadh, Saudi Arabia, from January to March 2026. Data were collected via a self-administered online questionnaire incorporating the Hospital Anxiety and Depression Scale (HADS), with a score ≥8 defining a probable case.
Results: The cohort was predominantly female (76.8%) with a median age of 23 years. Probable anxiety was identified in 55.1% of participants and probable depression in 31.4%; more than a quarter screened positive for both simultaneously. Female sex (aOR 2.82), younger age (aOR 0.94 per year), and a pre-existing psychiatric diagnosis (aOR 5.49) independently predicted anxiety. Prior psychiatric diagnosis was the strongest predictor of depression (aOR 8.24). Body mass index (BMI) was not independently associated with either outcome. The HADS demonstrated good internal consistency (Cronbach’s α = 0.85 for anxiety; 0.79 for depression).
Conclusion: More than half of isotretinoin users in Riyadh exhibited probable anxiety, and nearly one in three exhibited probable depression, with prior psychiatric history the single strongest predictor of morbidity during therapy. These findings supported the routine pre-treatment psychiatric screening, with heightened monitoring for female, younger, and psychiatrically vulnerable patients.

Key words: Acne vulgaris, isotretinoin, depression, anxiety, hospital anxiety and depression scale, Saudi Arabia