I stumbled upon this huge post while reading on an anti-Accutane forum. It's very helpful I thought, so i'm copying it here in case it gets removed there. It ignores all of the rhettoric surrounding the drug and looks at the facts. It lists almost all the studies that have been done on Accutane to date. But it's missing some of the newer ones.. I added those at the bottom of each list. I'm considering starting Accutane soon, and I figure this might help convince the Derm that i've done the research and acknowledge the risk (if there really is one.. it's debatable)
They are in order of in favor -AGAINST- first, and in favor -OF- second. This might not all fit in one post.
In favor AGAINST Accutane
1. Changes in the brain of patients treated with Accutane.
-Study by Bremner, et all. where PET scans were done on 28 patients split into two groups (13 taking Accutane, 15 taking Antibiotics) before and after 4 months of treatment. The Accutane group showed a decreased brain metabolism in the orbitofrontal cortex (-21% change versus 2% change for antibiotic), a brain area known to mediate symptoms of depression. However, there were no differences in the severity of depressive symptoms between the Accutane and Antibiotic group. This study suggests that Accutane treatment is associated with changes in brain functioning.
2. Accutane given to rats showed suppressed hippocampal cell division in the brain.
-Study by Crandall, et all. on mice. This study shows that Accutane given to the mice caused significantly reduced cell proliferation in the hippocampus and the subventricular zone, suppressed hippocampal neurogenesis, and severely disrupted capacity to learn a spatial radial maze task. It showed that the regions of the adult mouse brain where cell proliferation is ongoing are highly sensitive to disruption by Accutane. (I'm not really sure of the implications of this.)
3. Incidence of depression in patients treated with Accutane.
-Study by Hull, et all. where 124 patients were treated with Accutane
for 4 months. Depression occurred in 4% of the patients and tended to persist throughout the full course of the treatment. All patients completed the full course of treatment.
4. Psychosis reported in soldiers after treatment with Accutane.
-Study by Barak, et all. where cases were drawn from 500 soldiers who had been evaluated for severe acne (unknown whether or not all received Accutane). 5 of the soldiers developed manic psychosis within a mean of 7.6 months of exposure to Accutane. Either a personal history of obsessive-compulsive disorder, neurological insult or family history of a major psychiatric illness were present in all 5 cases.
5. Mice shown to have depression related to Vitamin A toxicity?
-Study by Lindamood, et all. Personally unable to interpret much of this study, but there is mention of 'weight gain depression' associated with a group of mice that were deliberately given Vitamin A toxicity. Symptoms of Vitamin A toxicity are known to be very close to those of Accutane.
Added 6. Increased use of mental health services related to Isotretinoin treatment: A 5-year analysis.
4.7% more of soldiers taking Accutane used 'Mental health services' compared to psoriasis control group.
Added 7. Chronic Administration of 13-Cis-Retinoic Acid Increases Depression-Related Behavior in Mice.
In favor OF Accutane
1. Data extracted from records of 21,911 patients from health database shows no link between Accutane and Depression.
-Study by Jick, et all. where patient records from Canada and UK Health Databases were statistically analyzed. Records were separated into two groups: one group of patients who took Accutane (7535 total), and one group of patients who took oral antibiotics (14376 total). All patients had computer-recorded histories of between 6 months and 5 years before, and at least 12 months after, their first Accutane or antibiotic prescription. Results showed that both Accutane and antibiotic groups, compared to the normal population, showed equal risk to prevalence of depression and suicide. (From my interpretation): It appeared that the Accutane group showed less risk of suicide than the antibiotic group.
2. Records from 2821 patients taking Accutane show no increase of prescription of anti-depressants compared to patients on antibiotic.
-Study by Hersom, et all. where patient records from a total of 9 months were examined for a link between Accutane and depression. There were 2821 patients on Accutane, although the abstract did not note the amount of patients on Minocycline. The analysis compared each drug prescription to the amount of anti-depressants prescribed to the patients. Neither drug showed an increased risk of depression or suicide compared to the general population based on amount of anti-depressants prescribed.
3. Study of 215 patients shows no difference in depression scores between Accutane and antibiotic/topical groups.
-Study by Tam, et all. where 215 patients were split into two groups: Accutane, and antibiotic/topical. Abstract does not note how many were in each group. Patients were given depression and quality of life tests. The Accutane group's scores showed no more incidence of depression than the antibiotic/topical scores. However, 5 of the Accutane patients were withdrawn from the study because of worsening of mood.
4. Study of 101 patients shows no increase of depression amongst Accutane users, actually a decrease.
-Study by Chia, et all. where 101 patients were put into two groups: Accutane group, and conservative therapy group (believed to mean antibiotic/topical). Each group followed the therapy for 3-4 months. Abstract does not note how many patients were in each group. Using the 'Center for Epidemiological Studies Depression Scale', scores from each group were measured. Depression scores after the study for Accutane patients were no higher than before the study. In fact, they were lower, as were the 'Conservative' group's scores, possibly indicating a link between depression and severity of acne.
5. Reduced anxiety and depression in 72 patients treated with Accutane.
-Study by Rubinow, et all. where one group of 72 patients were evaluated before and after treatment with Accutane. Substantial evidence of psychologic distress was noted before treatment with Accutane began. After treatment, significant reductions in anxiety were observed on several measures of anxiety, with the largest reduction in anxiety and depression in those patients whose acne was improved the most from treatment. Suggests a link between severity of acne and depression.
6. Study of 34 patients treated shows that Accutane produces a significant improvement across a wide variety of psychological functions.
-Study by Kellett, et all. The abstract does not seem to be very informative, as I had trouble understanding the meaning of it. The last two lines, the conclusion of the study, is what probably explains the result of the study best.
7. Pilot study of 23 Accutane patients fails to show a link between Accutane and depression, anxiety, or suicidal thoughts.
-Study by Ferahbas, et all. where a total of 23 Accutane patients were given the drug for 4 months, with depression and anxiety scores measured before and after the study with the 'Clinical Anxiety Scale and Montgomery-Asberg Depression Rating Scale'. Patients showed less anxiety based on anxiety scores after completion of the Accutane treatment. Depression scores also went down, but were not statistically significant. No patient committed or attempted suicide.
8. Accutane hinted at improving psychological problems.
-Study by Layton, et all. Abstract is not very forth-coming with information. One line probably provides the most: "In addition, the benefit of isotretinoin on psychological impact has also been highlighted by this work."
9. MedWatch reports of suicide concluded to not be a causal link to Accutane.
-Study by Jacobs, et all. This is not exactly a study, but rather a review of the evidence. The others concluded that the reported cases to not meet the criteria for establishing a link between Accutane and depression/suicide. Abstract is not very informative.
10. Four weeks of Accutane shows few signs of side effects in rats.
-Study by Ferguson, et all. (I did not really understand the results of this study, but since it mentions effects on the hippocampus in the brain of rats as mentioned above, possibly in a positive way, I thought it was worth adding.)
11. Systemic search of literature, 9 individual studies referenced and analyzed, no link between Accutane and depression found compared to antibiotic groups.
-Study by Marqueling, et all. It is not noted in the abstract which studies were referenced. It could simply be an overview of all of the studies mentioned already here. It was found that rates of depression among Accutane users ranged from 1% to 11% across studies, with similar rates in oral antibiotic control groups. Overall, studies comparing depression before and after treatment did not show a statistically significant increase in depression diagnoses or depressive symptoms. Some, in fact, demonstrated a trend toward fewer or less severe depressive symptoms after Accutane therapy.
12. Suicides reported in 16 acne patients. Accutane's important role in helping this?
-Study by Cotterill, et all. This abstract is not very informative, and it is not noted whether or not the 16 patients were actually on any acne treatment at the time the suicides occurred. However, the authors of the study did say this, praising Accutane, so it is doubtful that the patients were on Accutane at the time:
"Facial scarring, particularly in men, may be an 'at risk' factor for suicide, emphasizing the positive early therapeutic role of isotretinoin." This study seems to indicate that there is a link between acne and depression alone.
Added: 13. A prospective study of the responsiveness of depression and suicidal ideation in acne patients to different phases of isotretinoin therapy.
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