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m.d.student

Accutane & Depression = no proven link

Hey Whitehead,

Here are some articles (recent) that show that there is no known causation between accutane and psychiatric illness..all that stuff you hear in the news is garbage...journalists are not scientists, nor are they statisticians..you need a combo of both to make a sound decision...in summary, we don't know enough to firmly say yes that accutane causes depression, nor can we say it dosen't...what the evidence suggests that there is a whole gamut of other factors such has age, sex, genetics, psychosocial issues, that, in combination with accutane (if it does indeed play a role) that influence the psychiatric outcome of the patient - in the end though, I highly doubt that we will EVER know if accutane causes depression or not - depression has so many different etiologies..you must consider the self-esteem of the patient, does the patient have family members that suffer from depression, does the patient have a strong social network, does the patient have a personality disorder or suffer from anxiety, does the patient have a good outlook on life, does the person abuse drugs, is the person male female white black, etc....but I think that the reason for not going on accutane because you fear it causes depression might be a bit to extreme (assuming you dont have any of the risk factors that would predispose you to accutane).

J Dermatolog Treat. 2004 Jun;15(3):153-7.

BACKGROUND: Isotretinoin therapy and its alleged adverse psychiatric effects have received considerable media attention during the past years. The aim of this pilot study was to investigate whether there was any association between isotretinoin therapy and anxiety, depression or suicidal ideation. METHODS: Forty-five patients with severe recalcitrant acne were enrolled in this study. Isotretinoin was administered at a dose of 0.5-1 mg/kg per day in two divided doses with food for 16 weeks. All patients received a complete dermatological examination and the severity levels of their acne were scored according to the Leeds Revised Acne Grading system at baseline (before isotretinoin treatment) and follow-up assessments at weeks 4, 8 and 16 of the treatment. Severity of anxiety and depressive symptoms were assessed with the Clinical Anxiety Scale and Montgomery-Asberg Depression Rating Scale before and upon completion of the 16-week isotretinoin treatment. RESULTS: Twenty-three patients completed the final assessment. There was a statistically significant decrease in anxiety scores. Depression scores also decreased but were not statistically significant. No patient committed or attempted suicide. CONCLUSIONS: This pilot study was unable to detect an association between the use of isotretinoin and an increased risk for anxiety, depression, or suicidal thoughts.

J Am Acad Dermatol. 2001 Nov;45(5):S168-75.

This paper examines the existing literature and MedWatch reports concerning a proposed relationship between isotretinoin and depression and suicide. The authors provide a brief overview of the biology of isotretinoin and depressive disorder and find no basis for a putative molecular mechanism linking the two. They also address the complexities of Substance-Induced Mood Disorder (SIMD) as a psychiatric diagnosis and its relevance to isotretinoin. Based on this review, the authors conclude that there is no evidence to support a causal connection between isotretinoin and major depression or suicide, because reported cases do not meet the established criteria for causality. The authors also conclude, however, that it is important for dermatologists to be aware of the risk factors for suicide and to monitor patients who exhibit depressive symptoms.

Ann Pharmacother. 2003 Jul-Aug;37(7-8):1124-7

OBJECTIVE: To evaluate the relationship between isotretinoin and psychiatric illness in adolescents and young adults. DATA SOURCES: Primary literature located via MEDLINE (1966-December 2002). Key terms were isotretinoin, depression, psychosis, suicide, and adolescents. DATA SYNTHESIS: Information regarding depression was added to isotretinoin labeling in 1998 following a series of case reports and submitted to the MedWatch system. CONCLUSIONS: Although a causal relationship may exist between isotretinoin and psychiatric illness in adolescents and young adults, this has not been demonstrated in the literature. Until evidence establishes a presence or lack of causality, prescribers should exercise caution when treating adolescents and young adults with isotretinoin.

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Finally someone brings some tech to the discussion. I have also researched this issue as I myself have some history of depression (which I attribute in part to my acne) and have so far found 0 studies that suggest accutane causes depression. However, I have found many that suggest exactly the opposite.

A little OT, but I'd be interested to know whether this accutane phobia is an American phenomenon or if people in other countries feel the same way. From what I have read I get the feeling that people in Europe for example are less hesitant to try accutane or to blame the drug on other afflictions. Maybe other non-Americans can chime in here.

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journalists are not scientists, nor are they statisticians..you need a combo of both to make a sound decision...in summary, we don't know enough to firmly say yes that accutane causes depression, nor can we say it dosen't...

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Guest Craigems
A little OT, but I'd be interested to know whether this accutane phobia is an American phenomenon or if people in other countries feel the same way. From what I have read I get the feeling that people in Europe for example are less hesitant to try accutane or to blame the drug on other afflictions. Maybe other non-Americans can chime in here.

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