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Hi all,

I'm just curious about this (I've never had accutane). I'm 25 years old and have had acne since I was 15ish. Since I broke out at 15 I've never had clear skin or even "unnoticable" acne.

I've had the usual patches, particularly when younger, where I was too afraid to leave the house (I went around 6 months where I only went out to go to school) because I didn't want anybody to see me. At some stage after that I decided to fight back and not let it get to me. I forced myself to get a job where I'd constantly be seeing people and could not hide & this helped improve my confidence.

Still, even now if I'm having a bad patch I'll reject offers to go out to things that are 'non-standard'. Its obvious that the acne has affected me phsycologically although I don't feel its that much of a problem since entering my 20s.

I would expect that many people have felt similar or worse throughout their lives with the acne. One thing I've never had was any teasing or bullying over my skin - I've always been well liked by everyone and so most of the problems were in my head. Real but in my head :)

So my question was.. if people have been depressed over acne, possibly made worse by comments from others, etc. When they finally make the plunge to do Accutane you would expect that they have the feeling that "This is the last resort. If this doesn't work I'm stuck with this curse for life!"

When they find that the accutane doesn't work you'd expect some people to think their lives are over and that they cannot continue like this any more. I wondered whether this was the reason for high depression and even suicide rates, or have people experienced a massive depression that hasn't been created by their own thoughts?

Thanks.

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Accutane actually has very low depression and suicide rates >.1% of people taking it become depressed.

people don't know what causes depression but that could be one of the reasons. people feeling like their last resort drug isn't working fast enough. or their could be an actual medical link between accutane and depression, or it could just be a coincidence. no one knows for sure whether or not accutane causes depression.

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Study on Accutane and depression

Accutane may counter, not cause, depressive symptoms

Study shows link between acne tx with isotretinoin improved depression scores

Nov 1, 2005

By: Bill Gillette

CES Depression Scale

St. Louis  A recent study shows that isotretinoin has the potential to improve depressed mood among adolescent users much more often than to cause it, as the package insert warns.

According to a study conducted by a team of doctors at St. Louis University Health Sciences Center and later published in the May issue of Archives of Dermatology, the use of isotretinoin, particularly Accutane (Hoffman La-Roche), in the treatment of moderate to severe acne in adolescents was not associated with an increase in depressive symptoms. "On the contrary," write the study's authors, "our study shows that treatment of acne improves depressive symptoms."

FDA labeling decision

Accutane is a synthetic molecule derived from vitamin A, which is involved in growth and maintenance of skin. The drug prevents pimples by correcting abnormal follicular keratinization and shrinking the enlarged sebaceous glands that contribute to the primary pathogenesis of acne. Accutane has proved to be a highly effective drug in the treatment of severe acne, but data has emerged in recent years that suggest the drug may cause severe depression and even suicide in some patients.

In 1986, the Food and Drug Administration (FDA) mandated a change in the package insert to include the risk of depression. In 2000, the FDA mandated that this risk be placed on the package label with the words "Accutane may cause depression, psychosis and, rarely, suicidal ideation, suicide attempts, suicide and aggressive behavior."

Not convinced

Elaine Siegfried, M.D., associate clinical professor of pediatrics and dermatology, St. Louis University, and private practitioner at Kids Dermatology in St. Louis, is the study's corresponding author. Prior to initiating the study, Dr. Siegfried says she wasn't convinced that Accutane caused symptoms of depression, let alone suicidal ideation.

"I think it's important to note that suicide, sadly, is the No. 2 cause of death among teenagers in this country," she says. "I've treated hundreds of teenage patients with Accutane, and have had no patients with suicidal ideation or attempts and, thankfully, none who have committed suicide. Accutane is a drug that gets negative press because it can cause birth defects, so it already had a strike against it in terms of public perception. When statistics and case reports were released linking the drug to depression and even suicide in some teenage patients, we wondered whether there wasn't an overreaction  whether the depression issue could be colored by the angst over side effects that can lead to birth defects.

"To quote a fellow dermatologist, Dr. Richard Fried, 'Scientific data pales in comparison to well-orchestrated media sensationalism.'"

New research study

Dr. Siegfried and her colleagues at St. Louis University decided to conduct their own study among their moderate-to-severe acne patients. The study began in 1997 and was completed in 2002.

"Our study was not funded or supported in any way by any pharmaceutical company," Dr. Siegfried says. "In fact, we got no funding from any source. The lack of a budget was the reason for the study's shortcomings: the relatively small size and lack of randomization. It was a study designed to include patients we saw in our practice over a five-year period."

Study objective

The objective of the study was to determine whether patients with moderate to severe acne who were treated with Accutane showed an increase in depressive symptoms compared with a control group of similar patients treated with conservative therapy.

The researchers assessed 132 patients aged 12 to 19 for depression, using a simple, 20-question psychiatric instrument that had been validated in adolescents: the Center for Epidemiological Studies Depression Scale (CES-D). Scores of 17 and above were suggestive of depression. Of the 132 patients, 59 were treated with Accutane; the rest were treated with topical antibiotics, topical retinoids and oral antibiotics. Depression was assessed at baseline and reassessed about four months post-treatment.

Study results

The study showed that at baseline, 14.3 percent of the Accutane group had CES-D scores of 17 or higher, while 19.2 percent in the conservative-therapy group scored 17 or higher. At follow-up, 8.2 percent of the Accutane patients scored 17 or higher, while 15.4 percent in the conservative-therapy group scored 17 or more.

"What we saw in our study is the opposite of what spontaneous reporting and uncontrolled case reports have suggested, and which led to the FDA mandating warnings on the Accutane packaging," Dr. Siegfried says. "Our study suggests that far from causing depression, Accutane may have helped improve the mood of our patients as their acne cleared."

Study limitations

Dr. Siegfried emphasizes that her study was small and not randomized, and that larger, randomized studies would be required to address any doubts about a rare risk of depression, suicide or impulsivity associated with Accutane therapy.

"We asked the question because we thought the mandated warnings regarding serious depressive side effects that could lead to suicidal thoughts and action might have been overstated," she says. "Isotretinoin is now available in a generic formulation, so there is very little incentive for doing a larger study. Whether the FDA will take any further steps remains to be seen. The FDA's workings are often mysterious to me, and I seriously doubt that our findings will affect the package insert warnings regarding the risks of depressive side effects of Accutane."

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I dont care what roche says. I became depressed and i know 2 other ppl that took accutane and the same thing happened to them Bullshit it happens in taht small of a percentage. accutane makes ppl depressed and im still depressed even 2 years after i stopped taking it

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I dont care what roche says. I became depressed and i know 2 other ppl that took accutane and the same thing happened to them Bullshit it happens in taht small of a percentage. accutane makes ppl depressed and im still depressed even 2 years after i stopped taking it

Roche does say accutane can cause depression.

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I dont care what roche says. I became depressed and i know 2 other ppl that took accutane and the same thing happened to them Bullshit it happens in taht small of a percentage. accutane makes ppl depressed and im still depressed even 2 years after i stopped taking it

I'm sorry to hear that you became depressed on Accutane. But, I think the point of the study was not to say people on Accutane never get depressed, it was that it probably does not cause it as frequently as some of the media reports have indicated and that there is really very little data on the relationship between accutane and depression. Also, it is trying to point out that Accutane may alleviate depression more often than it causes depression (e.g, by clearing people up, depression may lift) and that people may be depressed while on accutance simply because they have a serious acne problem. It may also be that if people don't clear up on Accutane, they may get depressed since it is sometimes considered the last resort for clearing your skin when nothing else has worked.

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Another study on this subject

Does Isotretinoin Cause Depression?

Investigators found no evidence of a link.

The U.S. FDA has received increasing numbers of reports of depression and suicide in patients using isotretinoin. Though causation is still unproven, new product labeling and informed consent forms have been instituted. The question of isotretinoin-induced depression is complicated by the high baseline incidence of depression and suicide in the adolescent population and by the depression and stress associated with severe acne.

Investigators conducted a cohort study to evaluate changes in depressive symptoms among patients with moderate-to-severe acne who were treated with isotretinoin, compared with patients who received maximal conservative acne therapy. The investigators enrolled patients aged 12 to 19 from hospital-affiliated and community-based clinics in Missouri. Of 132 patients, 59 received isotretinoin, and 73 received conservative therapy; 101 patients completed the study; 75% of the isotretinoin group and 40% of the control group were male. After a dermatologist selected a treatment regimen in the usual fashion, the patient was invited to participate in the study. Before therapy and at 3 months of therapy, participants completed a standardized 20-item questionnaire on depression from the National Institutes of Mental Health. A score of 17 or higher indicated a significant risk for depression.

At baseline, 14% of the isotretinoin group and 19% of the conservative-therapy group scored 17 or higher. At 3-month follow-up, the percentages were 8% and 15% in the isotretinoin and conservative-treatment groups, respectively. The percentages of new-onset depression at 3 months were 4.1% and 3.8%, respectively. No differences were statistically significant. No patients receiving isotretinoin had suicide ideation during the course of therapy. One patient in the conservative-treatment group had suicide ideation at baseline.

Comment: Whether isotretinoin causes increased risk for depression and suicide is a difficult question. In this study, neither depressive symptoms nor suicide ideation increased with isotretinoin therapy, but we need randomized studies with larger numbers of subjects to confirm these findings (see JW Dermatol Oct 24 2000 for one large study that found no such association). It might be that rare individuals are genetically or metabolically predisposed to depression triggered by isotretinoin.

 Mary Wu Chang, MD

Published in Journal Watch Dermatology June 28, 2005

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I've read studies indicating that Accutane reduces Biotinidase levels, and as a result you end up with less Biotin in the body. This itself is how I think Accutane shrinks the sebaceous glands and as a result you get less sebum production, which for Acne sufferers is a good thing. However one of the side effects of a prolonged Biotin deficiency is said to be depression.

http://en.wikipedia.org/wiki/Biotin

"Initial symptoms of biotin deficiency include:

Dry skin Seborrheic dermatitis Fungal infections Rashes including erythematous periorofacial macular rash Fine and brittle hair Hair loss or total alopecia

If left untreated, neurological symptoms can develop, including:

  • Mild depression, which may progress to profound lassitude and, eventually, to somnolence
  • Changes in mental status
  • Generalized muscular pains (myalgias)
  • Hyperesthesias and paresthesias"

Cheers

Craig

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I dont care what roche says. I became depressed and i know 2 other ppl that took accutane and the same thing happened to them Bullshit it happens in taht small of a percentage. accutane makes ppl depressed and im still depressed even 2 years after i stopped taking it

This is nonsense. It does not constitute a controlled scientific study. How about this quote:

"However, experts on drug safety and suicide say no medical studies have drawn a direct link between Accutane and depression or suicidal thoughts."

"There are case reports," says Alan L. Berman, executive director of the American Association of Suicidology. "What is being done is cautionary, but it is not based on any true research that demonstrates that Accutane indeed is causative of suicide."

THis is exactly what applies to your personal experience. There is no way you can attribute it to the medication.

Accutane is an extremely safe and effective drug. The serious side effects like liver problems and blood lipid problems can easily be monitored with routine blood work and easily counteracted by reducing or stopping the med.

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zolio you dont know what your talking about. THere has been numerous law suits against roche, because there 14 year old son killed themselves. OR crashed an airplane on purpose. But roche says no connections because obviously they signed a waiver to accept that if you get depressed you will stop taking the drug. I kno there is a correlation between the two. Its obvious that i use to be hapy,and while on accutane i wanted to die. so dont speak of things you dont know

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From my own experience it's hard to say. I was already on antidepressants before taking accutane.

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OR crashed an airplane on purpose.

Witness the power of the media. Did you know that they did an autopsy on that kid (Charles Bishop) after he crashed his plane into a Tampa skyscraper? I bet you did not, because they found that he did not even have a trace of Accutane in his system. He had never even filled his prescription!

THere has been numerous law suits against roche, because there 14 year old son killed themselves.

14 year olds kill themselves quite often without being on Accutane. This proves nothing except that parents want to blame someone. Did you know that the rate of suicide while taking Accutane is significantly lower than the rate of suicide in the general population? Did you know that the reported rate of depression while on Accutane is significantly lower than that of the general population? There is even a well designed study that shows that rates of depression IMPROVE on Accutane as depressed acne sufferers see their skin improving.

The only reason there is even a warning on Accutane's box about depression/suicide is because a Congressman forced it to be on the labeling despite the lack of even a statistical coorelation. It's politics, not science.

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OR crashed an airplane on purpose.

Witness the power of the media. Did you know that they did an autopsy on that kid (Charles Bishop) after he crashed his plane into a Tampa skyscraper? I bet you did not, because they found that he did not even have a trace of Accutane in his system. He had never even filled his prescription!

THere has been numerous law suits against roche, because there 14 year old son killed themselves.

14 year olds kill themselves quite often without being on Accutane. This proves nothing except that parents want to blame someone. Did you know that the rate of suicide while taking Accutane is significantly lower than the rate of suicide in the general population? Did you know that the reported rate of depression while on Accutane is significantly lower than that of the general population? There is even a well designed study that shows that rates of depression IMPROVE on Accutane as depressed acne sufferers see their skin improving.

The only reason there is even a warning on Accutane's box about depression/suicide is because a Congressman forced it to be on the labeling despite the lack of even a statistical coorelation. It's politics, not science.

Yep, see the well-designed studies I posted above. I think this really highlights the problem that nowadays, many people get their information on things from the media (who have their own agenda of making the news more dramatic and they also often don't get things quite right), instead of getting information from the original sources (research studies, books, journals, etc.). And when the media does get it wrong, you rarely see any kind of public retraction of the information - this story of the teen crashing the plane is just one example of this. The media skew data and stories quite a lot to fit whatever is the hot news topic of the week.

That said, Accutane certainly can have some negative side effects - and I believe it should be reserved for serious or particularly resistant cases of acne. However, there really is very little data specifically linking it to increases in depression. Its really hard to determine if depression in acne patients on accutane is caused by the drug itself or if it is just simply caused by being a teenager (who have high rates of depression) or caused by having acne (acne sufferers of all ages have higher rates of depression than most other dermatological patient groups).

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I can see how people could become depressed on this stuff towards the end. I am nearing the end, and it is very hard for me to function normally, sometimes. I say this because of all the side effects I am dealing with that seem to be worsening by the day. Now, some people don't get those side effects and are wonderfully happy about their progress, while, others, like me are dealing with runny noses, cracked and bleeding lips, blood shot eyes, etc...

I am not saying that it does or doesn't cause depression. Just that I can see it happening to someone that is dealing with it like I am.

One must remain strong and fight it, if there are bad thoughts or the like. Basically, have faith that this is all worth it in the end!

K

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It can cause depression and mood changes.

When I first started taking it I couldn't stop laughing. Less than an hour after taking it laughing at all kinds of stuff. Especially when I went to 40mg. And I haven't had that much to be happy about lately.

So why do I say it can cause depression, because the next day I hadn't taken the drug for 24 hours now and have stopped laughing now needed my accutane fix to make me happy again.

Can't wait to see what happens when I stop taking the drug.

Hope it's not addictive.

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I dont care what roche says. I became depressed and i know 2 other ppl that took accutane and the same thing happened to them Bullshit it happens in taht small of a percentage. accutane makes ppl depressed and im still depressed even 2 years after i stopped taking it

:snooty: Rather say it CAN make people depressed.ive been on it for a month...and i can say i have had moments of being down but its the exact same sadness i had BEFORE going on the drug.So dont assume it ruins everyones lives.Many people come here to get motivated on taking the drug.Take the chapped lips,dry skin,sore joints,blood shot eyes and you will get annoyed.BUT take that ONE look in the mirror when you see progress and you KNOW its all worth it. :dance: I think WAY too many people who have mental and depression issues before goin on the drug blame it when its just themselves feeling sorry for oneself. :wall:

Just my rant :whistle:

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I dont care what roche says. I became depressed and i know 2 other ppl that took accutane and the same thing happened to them Bullshit it happens in taht small of a percentage. accutane makes ppl depressed and im still depressed even 2 years after i stopped taking it

:snooty: Rather say it CAN make people depressed.ive been on it for a month...and i can say i have had moments of being down but its the exact same sadness i had BEFORE going on the drug.So dont assume it ruins everyones lives.Many people come here to get motivated on taking the drug.Take the chapped lips,dry skin,sore joints,blood shot eyes and you will get annoyed.BUT take that ONE look in the mirror when you see progress and you KNOW its all worth it. :dance: I think WAY too many people who have mental and depression issues before goin on the drug blame it when its just themselves feeling sorry for oneself. :wall:

Just my rant :whistle:

Could it be that Accutane may make your symptoms (or same 'sadness') worse?

I ask this cause latelyI've been feeling pretty crappy and I know that this is the same thing I've felt before when i used to think I was depressed. I was actually happy and symptom-less before taking Accutane. and now I can't seem to think positive for even some hours.. :( I dontt want to go through this again.. i really thought i got over it (maybe Accutane brought it back??)

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Accutane is a big, scary drug and sometimes it hurts to take it. Acne, in itself, is disfiguring and embarrassing. This, combined with the fatigue the drug causes, can all add up to a very shitty mood. Plus, a lot of the people taking it are teens who have mood swings to begin with. Yikes! How can anyone dance around like a happy fool for 6 months on this drug?

If you feel worse than you've ever felt, please seek help. They can put you on an antidepressant temporarily.

Platinum

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Accutane is a big, scary drug and sometimes it hurts to take it. Acne, in itself, is disfiguring and embarrassing. This, combined with the fatigue the drug causes, can all add up to a very shitty mood. Plus, a lot of the people taking it are teens who have mood swings to begin with. Yikes! How can anyone dance around like a happy fool for 6 months on this drug?

If you feel worse than you've ever felt, please seek help. They can put you on an antidepressant temporarily.

Platinum

So Accutane DOES cause fatigue???

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So Accutane DOES cause fatigue???

That's what it says on my Rx notes that the pharmacy gives me. I haven't experienced much fatigue, though. I think any that I have is conteracted by the fact that my skin is no longer an oily mess and most of my cysts and lesions are gone. If I still had lots of cysts, I would probably be sleeping all day and hiding from everyone. Just the oil control makes me happy.

Side note about oil control: My derm said that after my course is over, if I wanted accutane for oil control she would rx a long term, low dose for me. YAY! Just don't know what insurance will say. We'll see.

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I think there may be something to your earlier observation that isotretinoin-induced fatigue seems to hit younger people worse than adults. I personally had it really bad my first course which i took as a teenager, and not at all for my second which i took as an adult. Of course that's purely anecdotal and doesn't prove anything, but it's consistent with your observation.

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I think there may be something to your earlier observation that isotretinoin-induced fatigue seems to hit younger people worse than adults. I personally had it really bad my first course which i took as a teenager, and not at all for my second which i took as an adult. Of course that's purely anecdotal and doesn't prove anything, but it's consistent with your observation.

Weird, huh? It interesting that you remember accutane being fatiguing when you took it the first time. Sort of goes to show that it's NOT the internet just scaring people into thinking they'll be depressed or tired. I'm sure you didn't read anything about side effects when you took it before.

I wonder what it does to cause fatigue. Kinda scary, if you ask me.

But, as long as my bloodwork comes back ok each month, I'll take this stuff the rest of my life if I have to.

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