Accutane / Roaccutane - Isotretinoin

Accutane, suicide and depression
(more research is needed)

Accutane & mental health

Patients have reported depressive symptoms while taking Accutane since shortly after the drug became legal in 1982. Whether the drug caused these depressive feelings remains a subject of intense debate. There are, after all, millions of people taking the drug, and there are bound to be people experiencing depression amongst them. Despite the confusion around this topic, Roche Pharmaceuticals®, the makers of Accutane, added a warning to its label regarding suicide and depression in 1998.

Media coverage on the topic spiked in 2000 when Michigan Congressman Bart Stupak's son BJ committed suicide while on Accutane. Research began in earnest to determine whether there is a causal link between Accutane, suicide & depression.1-2

Quite a few studies have been conducted since. These have included large population-based cohort studies, retrospective analysis studies, and relative risk estimates, performed in the United States, the UK, and Canada.3-11 The first of these studies showed no conclusive evidence linking Accutane with depression or suicide.1-2 As the studies mounted, the data continued to show no evidence of a link.7-9,12 One study published in the New England Journal of Medicine found "431 cases of depression, suicidal ideation, suicide attempts, or suicide in U.S. patients treated with isotretinoin," within a 10 year period. The article went on to note that the numbers listed do not exceed the U.S. suicide rate.13

If a researcher were to examine the evidence from 2000 until 2005, he or she would likely conclude that there is no evidence linking Accutane with suicide or depression.7-9 However, as is often the case, further analysis showed limitations to many of the studies.14-15 A general overview published in 2006 by the International Journal of Dermatology noted, "the overall lack of concrete scientific data limits any conclusion that can be drawn about a causal relationship between isotretinoin and psychiatric adverse events."16

Then, in 2006, depression-related behavior was shown in mice injected with the drug. While animal studies often do not reflect human models, it was marginally intriguing.10 But even more provocative was a large cohort case-crossover study published in 2008 by the Journal of Clinical Psychiatry, which was the first controlled study to find a correlation between Accutane, suicide and depression, albeit relatively minor.11 Two recent studies, one small American study and one large Swedish study, have lent more evidence to the lack of a connection between Accutane and depression and suicide.5-6

The preponderance of the evidence at this point is that Accutane does not appear to be linked with suicide and depression. However, to be safe, it is important for anyone taking Accutane to closely monitor their mental health while on the drug.1,4,17 If you find yourself feeling depressed or suicidal, seek help right away.

For help within the USA, call 1-800-SUICIDE / 1-800-784-2433
For help outside the USA, please see this page for hotlines in your country.

References

1. Jacobs DG, Deutsch NL and Brewer M. "Suicide, depression, and isotretinoin: is there a causal link?" Journal of the American Academy of Dermatology. 2001; 45(5): S168-75.

2. Jick SS, Kremers HM and Vasilakis-Scaramozza C. Isotretinoin use and risk of depression, psychotic symptoms, suicide, and attempted suicide. Archives of Dermatology. 2000; 136(10): 1231-6.

3. Hull PR and D'Arcy C. "Acne, depression, and suicide." Clinics in Dermatology. 2005; 23(4): 665-74.

4. Magin P, Pond D and Smith W. "Isotretinoin, depression and suicide: a review of the evidence." British Journal of General Practice. 2005; 55(511): 134-8.

5. Kaymak Y, Taner E. and Taner Y. "Comparison of depression, anxiety and life quality in acne vulgaris partients who were treated with either isotretinoin or topical agents." International Journal of Dermatology. 2009; 48(1): 41-46.

6. Sundstrom A, et al. "Association of suicide attempts with acne and treatment with isotretinoin: Retrospective Swedish cohort study." British Medical Journal. 2010 Nov. 11.

7. Chia CY, et al. "Isotretinoin therapy and mood changes in adolescents with moderate to severe acne: a cohort study." Archives of Dermatology. 2005; 141(5): 557-60.

8. Hersom K, et al. "Isotretinoin and antidepressant pharmacotherapy: a prescription sequence symmetry analysis." Journal of the American Academy of Dermatology. 2003; 49(3): 424-32.

9. Ferahbas A, et al. "A pilot study evaluating anxiety and depressive scores in acne patients treated with isotretinoin." The Journal of Dermatological Treatment. 2004; 15(3): 153-7.

10. O'Reilly KC, et al. "Chronic administration of 13-cis-retinoic acid increases depression-related behavior in mice." Neuropsychopharmacology. 2006; 31(9): 1919-27.

11. Azoulay L, et al. "Isotretinoin and the risk of depression in patients with acne vulgaris: a case-crossover study." The Journal of Clinical Psychiatry. 2008; 69(4): 526-32.

12. Cohen J, Adams S and Patten S. "No association found between patients receiving isotretinoin for acne and the development of depression in a Canadian prospective cohort." The Canadian Journal of Clinical Pharmacology. 2007; 14(2): e227-33.

13. Wysowski DK, Pitts M and Beitz J. "Depression and suicide in patients treated with isotretinoin [letter]." The New England Journal of Medicine. 2001; 344: 460.

14. Marqueling AL and Zane LT. "Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review." Seminars in Cutaneous Medicine and Surgery. 2005; 24(2): 92-102.

15. Wysowski DK and Beitz J. "Methodological limitations of the study "isotretinoin use and risk of depression, psychotic symptoms, suicide, and attempted suicide." Archives of Dermatology. 2001; 137(8): 1102-3.

16. Strahan JE and Raimer S. "Isotretinoin and the controversy of psychiatric adverse events." International Journal of Dermatology. 2006; 45(7): 789-99.

17. Wysowski DK, Pitts M and Beitz J. "An analysis of reports of depression and suicide in patients treated with isotretinoin." Journal of the American Academy of Dermatology. 2001; 45(4): 515-9.

Further Reading

Layton AM, et al. "Isotretinoin for acne vulgaris-10 years later: a safe and successful treatment." British Journal of Dermatology. 1992; 129: 292-296.

Magin P, et al. "Patients' perceptions of isotretinoin, depression and suicide-a qualitative study." Australian Family Physician. 2005; 34(9): 795-7.

Schwertz BA. "From the Food and Drug Administration: new measures to manage risks associated with Accutane." Journal of the American Medical Association. 2001; 285: 1146.