Medical professionals and acne-plagued teenagers have no doubts about the efficacy of isotretinoin, a drug for severe acne. It is the imminent possibility of side effects such as depression and fetal harm that makes people uncomfortable when considering using this drug.
Accutane (isotretinoin) is one of Hoffman-LaRoche’s most popular and controversial pharmaceutical products. This week, a study published in the Dermatology Archives claimed isotretinoin to cause depression. In this report, Christina Y. Chia, MD, of Saint Louis University Health Sciences Center, St. Louis, and colleagues examined whether patients with moderate to severe acne treated with isotretinoin experienced an increase in symptoms depressive compared with patients treated with a topical antibiotic. , topical retinoid, and an oral antibiotic.
Dr. Chia found that “the use of isotretinoin in the treatment of moderate-severe acne in adolescents did not increase depressive symptoms. In contrast, our study shows that acne treatment improves depressive symptoms.”
Five years earlier, in 2000, the relationship between isotretinoin and depression still seemed elusive. That time, he Dermatology Archives published a study, led by Dr. Susan S. Jick, of the Boston University School of Medicine, that found no evidence that isotretinoin increases the risk of depression, suicide, or other psychiatric disorders.
Although isotretinoin finds wide support among dermatologists and psychiatrists, a large number of parents, politicians, and medical professionals hail isotretinoin as a medical disgrace.
For example, Dr. David J. Graham, Associate Director for Science and Medicine at the FDA’s Office of Drug Safety, recently warned that Accutane should be withdrawn from the market.
And while there are few studies with negative observations about isotretinoin, research by Dr. Douglas Bremner at Emory University School of Medicine has linked isotretinoin treatment to changes in brain function. At the end of this study, published in the american journal of psychiatryDr. Bremner agreed with Dr. Graham’s opinion that isotretinoin is too dangerous for human use.
Dr. Bremner explains that in order to invoke depression, isotretinoin must influence the brain. During the investigation, the subjects’ brain function was measured by positron emission tomography (PET) before and after four months of isotretinoin treatment. Isotretinoin treatment was associated with decreased brain metabolism in the orbitofrontal cortex, the area of the brain known to mediate symptoms of depression. However, there was no difference in the severity of depressive symptoms between the isotretinoin and antibiotic treatment groups before or after treatment.
The pessimistic effects of isotretinoin also caught the attention of Diane K. Wysowski PhD. Dr. Wysowski noted that in June 2000, isotretinoin ranked in the top 10 drugs associated with depression and suicide attempts in the FDA’s Adverse Event Reporting System database. In 2001, Dr. Wysowski examined the depression-inducing potential of isotretinoin and published her findings in the Journal of the American Academy of Dermatology.
Dr. Wysowski concluded that more study of isotretinoin is needed. He also advised patients and their parents to immediately report mood swings and symptoms suggestive of depression, such as sadness, crying, loss of appetite, unusual fatigue, withdrawal and inability to concentrate, to their prescribing doctor. These protective measures may prevent more serious side effects and allow appropriate treatment, including consideration of drug discontinuation and referral to psychiatric care.
While there is still disagreement among researchers about whether or not isotretinoin causes depression, one idea that most of them can agree on is that more research on the side effects of isotretinoin is desirable. If you’re not in the mood to be an isotretinoin guinea pig, Geoffrey Redmond MD, author of The good news about female hormonessuggests using hormone therapy and/or using Retin-A if isotretinoin seems too lucky for you.
