I have been taking accutane for a few days and I already feel very messed up mentally. I have had terrible anxiety and cannot stop crying. To save myself from future torment, I have decided to stop. If I have taken 4 doses of 40 mg, how long will it take for it to be out of my system and for me to be back to normal?
Hi CS99. I took a full course of Roaccutane back in 2008, and it worked wonders for my skin. I didn't follow up with a second course and gradually started to relapse, so as of today I'm fourteen days into a second course of the same drug (though today the UK prescribes generic oral Isotretinoin, rather than Roche's branded Roaccutane).
A couple of hours after my first dose of this round, I began to feel completely very strange indeed. Although I was fully conscious and doing everything I was supposed to, I couldn't help shake the feeling that "something isn't right". I also started to get angry much more easily in the first few days of my course, and considered abandoning the treatment and returning to my dermatologist. As you'll know, Isotretinoin is a very strong drug (case in point: it's a derivative of Tretinoin, a chemotherapy drug) and minor mental disturbance does occur in some patients.
Nevertheless, these symptoms receded completely after around a week. I'm not sure if they are transient symptoms that disappear after a while (and that they'll therefore come back), or if my body and brain simply adjusted to the drug, or if there is some other explanation. You should stop taking the drug if you feel seriously disturbed, anxious, or depressed, but you should also return to your dermatologist in the next week or two, if you have already stopped taking the drug. They will be able to advise whether you should try to push through the symptoms, and they can also prescribe a different acne treatment if your symptoms are too severe.
I also understand that the dermatology community's consensus holds that the success (both immediate and long-term) of Isotretinoin therapy is based on the cumulative or total dose taken over a course of treatment, not the size of each dose taken. Therefore, the following courses would be equally as successful in the long term:
* One course of 40mg/day for 4 weeks then 80mg/day for 12 weeks
* One course of 20mg/day for 4 weeks then 40mg/day for 28 weeks
In short, your dermatologist could prescribe you a lower dose over a longer period of time -- which would mean you could enjoy the same rate of success from Isotretinoin, but with a greatly reduced chance of severe side effects such as anxiety. The dermatologists I have spoken to (my dad is a consultant dermatologist, so quite a few of the visitors to our house are ones too) are all very receptive to the notion of prescribing a lower dose over a longer period of time for patients who react badly to conventional therapies.
As for how long Isotretinoin will take to leave your system: the drug would be expelled from your body in under a day, but it is also composed of liposoluble elements (i.e. the drug is stored in your fat cells) and will hang around for an extended period of time. Nevertheless, these elements are present only at low volumes and could not cause latent side effects. Isotretinoin also causes some permanent changes to your body, but these changes are generally desirable ones; only a small number of patients develop so-called "permanent side effects". I know that when I delay a dose by a number of hours, even side effects like skin dryness are less severe -- and the drug has not, in those cases, even fully left my body.
I really hope things work out! Keep well.