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Hi guys! I'm new to this site, but I'm so frustrated at this point. I'm older and I never really dealt with acne very much until I was 18.. which seems to be the opposite of most people's experience. My acne is mostly cystic. It started on my chin and now I get them on my cheeks and forehead. They're miserably sore and take weeks to heal.
Anyway, so I went to my PCP at 18 or 19 for this and she put me on clindamycin topical gel and Retin-A topical gel. At first they worked pretty good. I always had at least mild acne, but it was an improvement so I was happy.
Fast forward a year and I go back to her for severe cystic pimples that were causing my lymph nodes to swell and generally just made me feel yucky. So this time she gives me oral doxycycline. When she prescribes me this, she tells me that if it doesn't work, she will have to refer me to a dermatologist for Accutane. My problem is that I know I will never be prescribed Accutane. I'm a woman of childbearing age and I have an immediate family history of mental illness. (not to mention I'm in nursing school and probably couldn't keep up with the appointments for lab work and everything). With all the drugs out there I highly doubt there is nothing else but Accutane.
That's why I'm so frustrated.. the oral antibiotics initially cleared up my cysts but they were back within a month or two full force. I have tried so many OTC products as well and my doctor is making me feel like I'm running out of options if I don't go on Accutane. I still use both of my topical meds and I am religious about washing my face morning and night, but nothing seems to touch my acne. 
Thank you guys so much for any responses. I don't really know anyone else my age that has acne as bad as I do, so I know it will be refreshing to get advice from people who have been there.
Unless you explicitly tell the doctor you have a history of mental illness or he somehow finds out you're on medication, there's no real way he will ever know and take this into account when considering Rxing Accutane.You either pledge abstinence or use two forms of birth control in order to be prescribed it. When it comes to Accutane and mood, it's highly unpredictable. Some people say they actually get less anxious and depressed since their skin clears beautifully on the med. In any case, working closely with a counselor and psychiatrist while you're on it is a safe route to go if you really want to take it.
I would second getting a hormone panel run. I finally got my results back, and more testing needs to be run, but at least I have some clues about what could be going on and where to go from here. You could probably benefit from doing the same.