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Roaccutane Side Effects And Existing Depression

roaccutane depression suicidal ideation side effects joint pain liver damage

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#1 MoonlitRiver

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Posted 05 August 2013 - 05:33 PM

Ok so I never imagined I'd find myself writing a post like this and this is by no means a decision on my part to take Roaccutane but I just wanted some advice from some of you lovely people who I know have personal experience with this drug. 

 

I've always been pretty determined not to take Roaccutane because of the horror stories, side-effects etc. and have got to the point now where I've tried pretty much every other treatment out there. But this year instead of my normal moderate acne I've developed horrific and painful cystic acne and have now been referred by my GP to a dermatologist because she said I'd be a very good candidate for Roaccutane. I therefore wanted to gauge a better idea of what the pros and cons of the drug might be for me before my appointment on 20th September. 

 

Obviously like everyone my main concern is the possible side-effects, in particular those related to joint pain, liver damage and depression/suicidal ideation. The first two are obviously just general concerns for my long-term physical health. What are your general views on this drug's infamous reputation? Do you think it's justified or do you think the dangers of it are overemphasised in the media?

 

Aside from these more general concerns the potential for depressive side effects is a particular worry for me as I have depression and am currently on anti-depressants which have greatly improved the condition for me (I should probably point out that my tendency toward depressive thinking predates my acne problems). So my other questions for anybody who might be able to answer are: 

  1. Will dermatologists prescribe Roaccutane for somebody with a history of depression?
  2. Can you continue to take anti-depressants (SSRIs) alongside Roaccutane or do they interact badly with each other?
  3. Are depression and/or suicidal ideation considered to be common side effects of Roaccutane and is it known to significantly worsen existing depression?

Thank you very much in advance to anybody who can help me with any of my questions smile.png

 



#2 biggs881

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Posted 05 August 2013 - 05:56 PM

1. If you depression is related mainly to your acne, then quite possibly yes.

2. Which SSRI are you on?

According to drugs.com, there is no interaction between isotretinoin (Accutane) and sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), fluoxetine (Prozac), or fluvoxamine (Luvox).

3. Depression and suicidal ideation are rare side effects of Accutane (see this graph).
 

Mood changes including depression are common among adolescents and have been reported in acne patients treated with isotretinoin. Two studies that looked at spontaneous reports of side effects for the FDA in the USA found little or no increase in psychiatric disease including depression and suicide over the background prevalence in the adolescent population. A further study of general practice databases in Canada and the UK showed similar findings as have subsequent studies. A more recent controlled case cross-over study demonstrated a relative risk for depression of 2.68 (95% CI = 1.03 to 3.89) for acne patients exposed to oral isotretinoin. This is the first controlled study to find a statistically significant association between isotretinoin and depression. Despite contradictory reports clinicians have been advised of a potential rare idiosyncratic reaction in some young vulnerable patients which could lead to mood changes and clinical depression during treatment with isotretinoin. It is therefore advisable to specifically enquire about related symptoms at each clinic visit.

If significant depression is identified, then a psychiatric referral may be indicated. Increased aggression has been identified in some male patients and the FDA in the USA has advised clinicians to warn potential patients about this side effect. If there is any doubt, the drug must be stopped.

 (Quote from here)

 

Other relevant/recent studies of Isotretinoin and depression:

 

http://www.ncbi.nlm.nih.gov/pubmed/19126049

http://www.ncbi.nlm.nih.gov/pubmed/23347302

http://www.ncbi.nlm.nih.gov/pubmed/18395669

http://www.ncbi.nlm.nih.gov/pubmed/17556790

http://www.ncbi.nlm.nih.gov/pubmed/23727704

http://www.racgp.org...200509magin.pdf

 

Good luck



#3 CWR24

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Posted 05 August 2013 - 07:30 PM

Acne makes me depressed. Accutane is my antidepressant lol



#4 MoonlitRiver

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Posted 06 August 2013 - 04:51 AM

1. If you depression is related mainly to your acne, then quite possibly yes.

2. Which SSRI are you on?

According to drugs.com, there is no interaction between isotretinoin (Accutane) and sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), fluoxetine (Prozac), or fluvoxamine (Luvox).

3. Depression and suicidal ideation are rare side effects of Accutane (see this graph).
 

Mood changes including depression are common among adolescents and have been reported in acne patients treated with isotretinoin. Two studies that looked at spontaneous reports of side effects for the FDA in the USA found little or no increase in psychiatric disease including depression and suicide over the background prevalence in the adolescent population. A further study of general practice databases in Canada and the UK showed similar findings as have subsequent studies. A more recent controlled case cross-over study demonstrated a relative risk for depression of 2.68 (95% CI = 1.03 to 3.89) for acne patients exposed to oral isotretinoin. This is the first controlled study to find a statistically significant association between isotretinoin and depression. Despite contradictory reports clinicians have been advised of a potential rare idiosyncratic reaction in some young vulnerable patients which could lead to mood changes and clinical depression during treatment with isotretinoin. It is therefore advisable to specifically enquire about related symptoms at each clinic visit.

If significant depression is identified, then a psychiatric referral may be indicated. Increased aggression has been identified in some male patients and the FDA in the USA has advised clinicians to warn potential patients about this side effect. If there is any doubt, the drug must be stopped.

 (Quote from here)

 

Other relevant/recent studies of Isotretinoin and depression:

 

http://www.ncbi.nlm.nih.gov/pubmed/19126049

http://www.ncbi.nlm.nih.gov/pubmed/23347302

http://www.ncbi.nlm.nih.gov/pubmed/18395669

http://www.ncbi.nlm.nih.gov/pubmed/17556790

http://www.ncbi.nlm.nih.gov/pubmed/23727704

http://www.racgp.org...200509magin.pdf

 

Good luck

 

Thank you so much for all the information you've provided biggs881!! The graph is especially interesting, obviously the depressive side effects are less common than I thought. I guess they must just be played up a lot by the anti-Accutane contingent. For me it's definitely exacerbated by the acne but I'm pretty certain it would be there to some degree anyway. I'm on Sertraline so it looks like it wouldn't react badly with Isotretinoin, which is good because I'm definitely not ready to be off them just yet! Thanks for giving me such a detailed and helpful reply :) 

 

Acne makes me depressed. Accutane is my antidepressant lol

 

Well yeh there is that factor to consider! Acne definitely makes depression worse and/or causes it in the first place. I take it Accutane worked pretty well for you then? I'd love to hear about your experiences with it :)



#5 amandacarleen

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Posted 16 August 2013 - 10:55 PM

I'm about to start taking Accutane next month and I take Zoloft. I have a past history of depression but my derm still prescribed it to me. I know that if I start to get depressed, I'll talk to my parents and my derm. I've warned my boyfriend too and he says he'll tell my parents if I start to seem depressed and won't tell anyone. :P Both my mom, dad, and brother have taken Accutane before. My mom is particularly watchful because a long time ago (maybe 30+ years) her friend's daughter committed suicide while taking Accutane. But I'd hope since then that they've improved the formula or whatever. If you do decide to take it and you start feeling depressed, you have to tell someone!! 



#6 MoonlitRiver

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Posted 17 August 2013 - 07:10 AM

I'm about to start taking Accutane next month and I take Zoloft. I have a past history of depression but my derm still prescribed it to me. I know that if I start to get depressed, I'll talk to my parents and my derm. I've warned my boyfriend too and he says he'll tell my parents if I start to seem depressed and won't tell anyone. tongue.png Both my mom, dad, and brother have taken Accutane before. My mom is particularly watchful because a long time ago (maybe 30+ years) her friend's daughter committed suicide while taking Accutane. But I'd hope since then that they've improved the formula or whatever. If you do decide to take it and you start feeling depressed, you have to tell someone!! 

 

Thanks for your reply! I'm really hoping I won't need to take Accutane but it's good to know that Zoloft can be used alongside it if I do because the prospect of stopping that at the moment is not very appealing! Problem is I don't trust myself to tell anyone if it gets bad because nobody even knows about it as it is, not even my parents, and the worse I feel the less likely I am to tell someone. But anyway I'm hoping the dermatologist can offer me some alternatives because I don't want to take Accutane if I can avoid it. Good luck with your course though, wish you all the best! :)



#7 LillyRose7

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Posted 18 August 2013 - 02:23 PM

hello :)

 

i see you are on dianette, which i know is very good at clearing up acne. My cousin had horrific acne all over her face, even near her eyebrows and if you look at her now, 7 months later, its like she never had acne. I heard dianette isnt good to be on long term though, can cause depression, mood problems etc and is usually just used for 3-6 months then you switch to another pill. I took it when i was 16 but i had bad side effects so stopped. I take another pill now which takes care of the acne problem (i have a hormonal problem) but i get the occasional spot obviously.

i was prescribed accutane about 2 years ago, but my mom was at the consult and told the doc about my history of depression and the doctor wouldn't prescribe it. She said she noticed 'mood changes', not necessarily depression, but anger/hostility/anxiety increase in her patient, about 70% of them. But if your acne is the source of your depression, then this could lift the feeling because you would feel you would be controlling and helping the situation.

just be careful if you take it. Worse case scenario, if you feel more depressed and low than usual, stop taking it immedietly.



#8 MoonlitRiver

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Posted 18 August 2013 - 05:49 PM

hello smile.png

 

i see you are on dianette, which i know is very good at clearing up acne. My cousin had horrific acne all over her face, even near her eyebrows and if you look at her now, 7 months later, its like she never had acne. I heard dianette isnt good to be on long term though, can cause depression, mood problems etc and is usually just used for 3-6 months then you switch to another pill. I took it when i was 16 but i had bad side effects so stopped. I take another pill now which takes care of the acne problem (i have a hormonal problem) but i get the occasional spot obviously.

i was prescribed accutane about 2 years ago, but my mom was at the consult and told the doc about my history of depression and the doctor wouldn't prescribe it. She said she noticed 'mood changes', not necessarily depression, but anger/hostility/anxiety increase in her patient, about 70% of them. But if your acne is the source of your depression, then this could lift the feeling because you would feel you would be controlling and helping the situation.

just be careful if you take it. Worse case scenario, if you feel more depressed and low than usual, stop taking it immedietly.


Hey! Thank you so much for your reply! It's so unbelievably good to hear that Dianette worked so well for your cousin. I too have got them in the eyebrows haha (it's really frustrating because you can't even treat those with BP because of the bleaching effect!) I'm definitely planning to give it a good chance of working before seriously considering Roaccutane. My doctor's prescribed me 6 months worth so I really hope I get similar good results! Not sure what I'd do after the 6 months though, do you mind me asking what pill keeps your acne under control now? My hormones are also all over the place. 

Yeh it seems to be a difficult conundrum! I'm certain that my tendency towards depressive thinking predates my acne (from about age 11) but I don't know if it was ever clinical before the acne came (aged 13) and the acne certainly exacerbates it. However, I only got it formally diagnosed this year (aged 21) after finally convincing myself to see a doctor about it, so I suppose because they would have no way of knowing that the tendency predated the acne they might prescribe it to me anyway. Ah well, cross that bridge if I get to it! Really hoping the Dianette will stop me having to! 



#9 HeftyMug

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Posted 18 August 2013 - 06:03 PM

Acne makes me depressed. Accutane is my antidepressant lol

 

haha same here.



#10 MoonlitRiver

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Posted 20 September 2013 - 04:06 PM

Just thought I'd update this thread in case anyone is interested in this issue in the future. I finally had my dermatology appointment today and whilst the dermatologist thought that a low dose course of isotretinoin was the best chance of getting my skin under control he flatly refused to prescribe it to me unless I get myself assessed and treated by a psychiatrist first because he's too worried about the suicide risk. However, seeing as uncontrolled acne significantly increases depressive symptoms in itself I sort of fail to see what is to be gained by not trying the isotretinoin and just ending up feeling progressively worse about my skin. I do have another appointment in 2 months time though and if I'm still having bad acne problems at that point I hope he might reconsider.






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