Updated December 29, 2014.
What do we know about Accutane and depression?
Isotretinoin, better known by its trade name Accutane, is a potent systemic drug used to treat severe nodular and cystic acne. First made available in 1982, Accutane can help control acne that is unresponsive to other treatments. Accutane is helpful in clearing stubborn cases of acne but comes with a slew of possible side effects, the most controversial of these an increased risk of depression and suicidal behavior.
In 1998, Roche Laboratories addressed a letter to physicians stating in part:
“Accutane may cause depression, psychosis and, rarely, suicidal ideation, suicide attempts and suicide. Discontinuation of Accutane therapy may be insufficient; further evaluation may be necessary. No mechanism of action has been established for these events.”
Warnings were also put in place by the U.S. Food and Drug Administration because of the large number of reported psychiatric disorders in those exposed to Accutane. According to the FDA, between 1982 and 2000, there were 394 reported cases of depression and 37 suicides of people who were taking, or had taken, isotretinoin. Thirteen of these suicides occurred within three months after the patient had stopped using Accutane.
Accutane ranks fifth in reports connected to depression, compared with all drugs listed in the FDA’s Adverse Event Reporting System (AERS) database through June 2000. It is also listed within the AERS top ten drugs associated with suicide and suicide attempts. It is the only non-psychotropic drug listed.
Finding the Link
Many case studies have found a potential connection between Accutane use and psychiatric disorders, and some studies have found Accutane causes depressive behavior in mice. Depression occurred in some people with no prior history of the disorder. Other patients had factors, such as substance abuse, a family history, or stressful events in their lives, which may have contributed to their depression.
Some Accutane users found that their symptoms of depression resolved once they stopped using the drug, and came back when it was reinstated. It should be noted, however, that depression and suicidal behavior persisted in some cases, even after the patient quit using isotretinoin.
Researchers at the University of Bath, UK believe Accutane may disrupt the way serotonin is made and utilized by the body. Low levels of serotonin have been linked to depression, bipolar disorder, anxiety disorders, and aggression. Their research identifies a possible mechanism for the link between depression and isotretinoin.
Why the Controversy?
While countless case reports suggest a relationship between Accutane use and depression, proving this connection has been difficult. Some studies suggest acne itself is more likely to cause depression in sufferers than Accutane use. Others have found no definitive link between Accutane use and an increased risk of depression.
Many acne sufferers find they are depressed because of their acne, and isotretinoin helps to clear their skin, making them feel less depressed and more confident.
Watch for Warning Signs
Reports of depression, psychosis, and suicidal behavior linked to Accutane use can be scary, but it’s important to understand that these side effects are rare. If you or your child is taking Accutane , watch for any symptoms of depression or psychosis, including but not limited to:
- Changes in mood and behavior
- Feeling unusually sad, angry, irritable, or aggressive
- Trouble concentrating
- Suicidal thoughts, or thoughts of hurting yourself
- Seeing or hearing things that are not real
If you have any concerns whatsoever, notify your doctor immediately. It’s important to be vigilant, but realize that most people can use Accutane without ever experiencing any psychiatric problems.
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