Drug Points Depression induced by etretinate

Drs C A HENDERSON and A S HIGHET (York District Hospital, York Y03 7HE) write: We report three cases of depression associated with etretinate treatment. In 1984 a 49 year old, 90 kg man with plaque psoriasis started taking etretinate 100 mg/day. Despite a reduction in dose the drug had to be discontinued owing to peeling skin, thinning hair, and depression. These effects resolved a few weeks later. In 1986 etretinate was restarted. Depression recurred, although it was minimal at doses below 50 mg/day. A 60 year old, 70 kg housewife with plaque psoriasis started taking etretinate 75 mg/day. After six weeks she became "extremely depressed." Etretinate was discontinued and her mood returned to normal in a few weeks. In 1985 a 38 year old, 100 kg man started taking etretinate 100 mg/day for plaque psoriasis. This was discontinued because of mucocutaneous side effects. In retrospect he admitted to mild depression. Etretinate 50 mg daily was restarted in 1986. This was followed by deep depression, which took two months to resolve after discontinuation of etretinate. All three patients were otherwise well and had no history of depression. No concurrent drugs were taken except ibuprofen 1 2 g/day by the second patient. All three patients admitted to an alcohol intake of 14 to 32 pints of beer weekly. Depression has been reported with isotretinoin' and etretinate.4 The manufacturers know of one further case implicating etretinate. The alcohol intake of the patients may be relevant as hepatic steatosis is associated with higher concentrations of etretinate in liver biopsy samples,6 and this may have affected the drug's subsequent metabolism.