LAUSR

Depression Screening in Dermatology— Think Isotretinoin To the Editor We applaud McDonald et al for publishing “The PHQ-2 in Dermatology—Standardized Screening for Depression and Suicidal Ideation.”1 The importance of this work cannot be overemphasized. We agree that dermatologists are uniquely situated to identify psychiatric concerns related to skin disease, and the PHQ-2 (Patient Health Questionnaire-2)2 is a great screening tool for this. Since we published on the use of the PHQ-2 in the context of isotretinoin,3 we have had positive feedback on its use and wish to reemphasize the importance in association with the article by McDonald et al. Additionally, we believe that their algorithmic approach warrants an expansion. Our team encourages McDonald et al1 to broaden their discussion and apply their algorithmic approach to psychiatric conditions beyond those that develop in response to dermatologic diseases. Regardless of whether the psychiatric condition or dermatologic condition came first, screening for depression and suicidal ideation should occur if concern exists or if a patient has a disorder commonly associated with increased depression and suicidal ideation like acne vulgaris, psoriasis, or atopic dermatitis. As it pertains to assessment of depression and suicidal ideation, 2 issues explicitly noted in the iPLEDGE consent form for isotretinoin use (https://www.ipledgeprogram.com/), we especially support the use of the PHQ-2. We have long believed that it is unreasonable to ask patients to acknowledge these issues in the iPLEDGE consent without offering them any objective screening guidance; therefore, we use baseline depression screening for 100% of our patients before prescribing isotretinoin. We also recommend that the Patient Health Questionnaire-9 (PHQ-9) follow the PHQ-2 after a positive screen.3 The PHQ-9 can even be administered if there is the slightest concern for additional risk. The PHQ-9 allows for identification of major depression and suicidal ideation while also improving identification of those patients with depressive disorders that will ultimately affect their dermatologic outcomes, overall health, and need for specialist assistance.3 This lack of defined screening from a governmentapproved drug safety program (ie, iPLEDGE) further highlights the important role dermatologists can play in these serious conditions. In closing, we are grateful for the piece by McDonald et al.1 With the prevalence of increased psychiatric disorders in dermatologic patients, it will take all of us to improve outcomes.3,4 We encourage further publications and new research into this area so that together as dermatologists we can collaborate to help improve the lives of those who make all our hard work count.