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 amongs 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.

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. The first of these studies showed no conclusive evidence linking Accutane with depression or suicide. As the studies mounted, the data continued to show no evidence of a link. 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.

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. However, as is often the case, further analysis showed limitations to many of the studies. 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."

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. 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.

The bottom line at this point is that we simply do not know if Accutane is linked with suicide and depression, and if so to what degree. Therefore, it is important for anyone taking Accutane to closely monitor their mental health while on the drug. 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

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 Apr; 69(4): 526-32.

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

Cohen J, Adams S, 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 Summer; 14(2): e227-33.

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

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

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

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

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

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 Sep; 34(9): 795-7.

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

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

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

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.

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

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

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

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