Would you be comfortable using isotretinoin in a female teenage patient who has a history of depression that is now stable but with a prior suicide attempt two years ago?  

Yes, assuming she failed spironolactone (off-label) and was getting therapy, parents involved, etc.

Yes. There is ample evidence that isotretinoin does not cause depression. In the large Canadian study, there was a slightly negative association with suicide. As the good doctors noted above, using appropriate step therapy, with informed consent (especially regarding pregnancy and birth defects), is...