An 18-year-old woman on isotretinoin reports mood changes and thoughts of self-harm. What is the most appropriate action?

• A. Continue isotretinoin and monitor mood
• B. Increase isotretinoin dose
• C. Switch to another retinoid without informing doctor
• D. Stop isotretinoin and inform GP and dermatology team

Answer: (D)

The key idea is recognizing that isotretinoin can cause mood changes and suicidal thoughts, so patient safety requires urgent action rather than continuing or adjusting treatment. When someone on isotretinoin develops mood symptoms or self-harm thoughts, stopping the drug promptly reduces exposure to the potential adverse effect. It’s essential to involve the GP and the dermatology team right away so a mental health assessment can be done, safety planning can be arranged, and a plan for alternative acne therapy can be discussed. This coordinated approach also ensures appropriate follow-up and monitoring, and helps rule out other contributing factors. It would be unsafe to continue the medication or to modify the dose without medical oversight, and switching to another retinoid without informing the treating clinicians could miss a serious safety issue. If there’s any immediate risk, urgent escalation to emergency services is warranted while the teams coordinate care.