My boyfriend broke up with me over “incompatibility” but I think Accutane and other changes might be affecting his emotions — could he change his mind once he's off it?

Hey everyone, I (23F) recently went through a really painful breakup with my boyfriend (22M), and I’m struggling to make sense of it. We’ve had a long, somewhat complicated history. We first dated when he was 19 and I was 20 for about a year, then were in a situationship for two years before officially getting back together after I graduated college. During my gap year, he was a senior, and we spent about 8 really happy months together in our small college town. We both moved to a much bigger city around the same time—me for grad school and him for a job at a bank firm that’s about 45 minutes north of where I live.

Around the time we moved, he also started a high dose of Accutane (60mg) for severe acne. Since then, he’s changed a lot—he’s become more withdrawn, irritable, and emotionally distant. He told me he’s just been unhappy ever since we got here and that the distance between us is "too much for him." But that unhappiness started at the exact same time he began Accutane and started adjusting to life in a completely new city and a high-stress job. I don’t think he sees the connection. He doesn’t really believe in depression or how meds like Accutane can affect your mood, but I’ve noticed such a big shift in him—he used to be warm, loving, and very connected with me.

When we broke up, he said he’s been thinking about ending things for about two months and that we’re just "incompatible." His reasons? Things like me not giving an exact ETA when I leave my apartment, not rerolling toilet paper to a specific length, using the “wrong” light switch in his bathroom, or how I take shortcuts while driving (like going through parking lots), which he says is “unattractive.” I have ADHD but really make an effort to understand his preferences and meet him halfway—he’s very Type A, and I’m somewhere in the middle. He even admitted everything else about me is great, but these things cause him resentment. He also said he feels unhappy whether I’m there or not, and that maybe I’m part of the reason—even though he loved me deeply before all this.

I asked if we could just take a break until he’s off Accutane and feels more like himself, but he said no and that we’re not getting back together. I still love him and this feels so sudden and confusing, especially because the timeline lines up so closely with big life changes and the medication.

So my question is: Could Accutane and the stress of change really be impacting him this much without him realizing it? Is it possible he’s misplacing his unhappiness onto our relationship? And is there a chance he might change his mind once he’s off Accutane and feeling more stable—or should I just accept that it’s over and try to move on, even if this doesn’t feel like the real “him”? Also: like what kind of girl could someone like him even be with?? He literally told me he knows he’s going to regret this for the rest of his life so idek

summary: Why we broke up (his reasons):

1    He said we’re “incompatible.”

2    He’s been feeling unhappy since moving to the city.

3    He thinks the 45-minute distance between us is “too much.”

4    He brought up small things like:

◦    Me not giving an exact ETA when I leave my place.

◦    Not rerolling the toilet paper to a specific length.

◦    Using the “wrong” light switch in his bathroom.

◦    Taking shortcuts while driving (he said it's “unattractive”).

5    He said these things build up resentment for him, even though he admitted everything else about me is great.

6    He said he feels unhappy whether I’m there or not — and maybe I’m part of the reason.

What I think is really going on:

1    He started taking high-dose Accutane (60mg) when we moved — it can severely affect mood.

2    He’s in a new, stressful job in a big city.

3    He’s emotionally changed — more withdrawn, irritable, distant — since all that started.

4    He doesn’t believe that medication or depression can affect emotions, but I’ve noticed a huge shift in him.

5    He told me he knows he’ll regret this for the rest of his life, which makes me think he's confused and acting out of stress/emotional fog.