From the FDA Drug Label
Signs and symptoms of depression, as described in the brochure (“Recognizing Psychiatric Disorders in Adolescents and Young Adults”), include sad mood, hopelessness, feelings of guilt, worthlessness or helplessness, loss of pleasure or interest in activities, fatigue, difficulty concentrating, change in sleep pattern, change in weight or appetite, suicidal thoughts or attempts, restlessness, irritability, acting on dangerous impulses, and persistent physical symptoms unresponsive to treatment. Signs and symptoms of depression include sad, “anxious” or empty mood, irritability, acting on dangerous impulses, anger, loss of pleasure or interest in social or sports activities, sleeping too much or too little, changes in weight or appetite, school or work performance going down, or trouble concentrating, and also include fatigue.
Fatigue is a symptom of depression that may be experienced by patients taking isotretinoin, as stated in the drug label 1 and 1.
From the Research
Fatigue is a common side effect of Accutane (isotretinoin), and if you're experiencing it, you should continue your prescribed dosage but consult your dermatologist about your symptoms, as they may recommend adjusting your dose or splitting it throughout the day to minimize fatigue. The exact prevalence of fatigue as a side effect of Accutane is not well-documented in the provided studies, but it is acknowledged as a potential side effect 2, 3, 4. While on Accutane, it is essential to prioritize getting 7-9 hours of sleep nightly, staying well-hydrated with at least 2-3 liters of water daily, and maintaining regular physical activity as tolerated. Taking your medication with food containing some fat can improve absorption and potentially reduce side effects.
The fatigue typically occurs because Accutane affects cell metabolism and may temporarily alter thyroid function in some patients. Most patients find that fatigue improves after the first month of treatment or resolves completely after completing the full course (usually 4-6 months) 3. If fatigue is severe or accompanied by other concerning symptoms like extreme weakness, dizziness, or mood changes, contact your healthcare provider promptly as this may require further evaluation. It's also important to note that Accutane may cause mood instability, including depression and mania, especially in patients with a personal or family history of mental illness 2.
In terms of management, a comprehensive approach including proper sleep hygiene, a healthy diet, and balancing energy expenditure can help address fatigue 5. Cognitive behavior therapy, exercise therapy, and acupuncture may also be beneficial for some patients. However, it's crucial to prioritize the management of underlying conditions and comorbidities, especially in patients with chronic fatigue syndrome or similar conditions 5.
Given the potential for ocular manifestations, including evaporative dry eye disease, it's essential to monitor for these side effects and refer to an eye specialist if necessary 6. Overall, the management of fatigue in patients taking Accutane requires a holistic approach, considering the potential effects on physical and mental health, and close monitoring by a healthcare provider.