Ok, I'm in the same boat as you OP. I don't feel like my acne is terrible, but derms always are suggesting accutane. As my fiancé puts it "it's not your acne that's that bad, it's the fact that you're 24 and still have acne that's bad..." so they're trying to just knock it out. I have history of depression and suicidal thoughts so I am avoiding it as long as I can.
Which is kind of amazing, because I usually give in to doctors and take whatever they give me, which is usually antibiotics. I have a pep talk before I go in to my appointment about how I will insist on no antibiotics, refuse them, ask for new methods, but I always just nod and go "ok" and cross my fingers and hope and pray that this time, this time it will work. They never do. I've have oral thrush for 2 years after rifampin. I now get yeast infections and BV every time I take an antibiotic. I vomit and get horrible horrible headaches an hour after I take an antibiotic, to the point I have to stop everything I'm doing and lay on my bed and cry, with or without food. My HS Flames up and gets worse 3 days after antibiotics. And - the icing on the cake - I am fucking horrible at taking all my antibiotics on time, or finishing my bottle. I am the person who is going to bring on the end times. I recently found all antibiotic containers in my closet (about 10) and not a single one of them was empty. Some had only 4 left, some had only 2 missing. I have Nexplanon so I don't have to worry about taking a BC pill every day. I struggle taking a multivitamin or anti-anxiety everyday. I am not on antidepressants because I can't commit to taking a pill at the same time everyday. It's a symptom on my depression and a curse, not a case of being lazy or uncaring. I fucking hate this about me and I know it's dangerous and bad. But I can't help it.
This derm last week was shilling accutane and I told her I didn't live here so I couldn't take it. So she suggests an antibiotic. Here it comes... Until I actually said "no. I really don't want one." I actually fucking said I didn't want antibiotics. Finally. After years and swearing I would I finally did. And I told her "I'm also one of those people who never finishes the prescription. But you know, there's a topical ointment I've had good success with and I use that fine."
And she said ok and gave me a refilling prescription of gentamicin sulfate ointment no problem. I told her "I already rub vaseline on my face every night so it's no different". I'm so glad I fessed up to my mistakes and that she listened. I haven't had that in a long time.
Just saying, yes doctors like to shill certain products and it's our first reactions to think "they're the professional they know what's best" when sometimes that's not the case. Sometimes their rushed or stubborn or don't know your lifestyle. the downfall to rejecting certain medications is the results won't be as great, but I'll take acne over suicide, yeast infections or constantly feeling like I'm going to die any day. (Or causing the zombie apocalypse single handedly)