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so what is in accutane that causes depression?

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It doesn't.

At worst it indirectly exacerbates a pre-existing tendency to depression-- which is only to be expected really in Accutane's primary patient demographic, i.e. a teenager with severe acne-- either through the initial breakout ("Oh god this is the one thing that can cure me and now my acne is actually worse than ever") or in exceptional cases of the medication not working ("Oh god this was the one thing could cure me and now I'm never going to be free of acne").

The warnings about depression never used to be mentioned at all in the Accutane medication guide because there was only the flimsiest of anecdotal correlation between the two, even then simply for the above reasons.

The notion of Accutane causing suicide is even farther removed from evidence because the rate of suicide among Accutane users is actually substantially lower than the rate of suicide in the general population (even when accounting for the general population itself comprising Accutane users), i.e. you're a greater threat to yourself off Accutane than you are on it.

The "connection" became hyped up to the extent we see today after Congressman Bart Stupak waged a campaign against Accutane based upon the belief that his son committed suicide because of severe depression resulting from the medication. Every time a drug is debated in Congress, Accutane comes up at some point and more and more politicians jump on the bandwagon to attack it.

The misapprehension that Accutane does more harm than good is one of the most tragic misconceptions in the history of the FDA. Is Accutane perfectly harmless? Not at all. Is its rate of risk in the context of what it achieves for those who need it acceptable. Absolutely. When properly administered and supervised, and prescribed to a patient in sound physical and mental health, Accutane offers the closest the modern world has to a cure for a potentially life-crippling condition.

It is prescribed to 500,000 individuals in the US alone every year, so inevitably that <1% who suffer significant and/or permanent side-effects are a sufficient enough number to appear much larger than the 99% who have their lives transformed and feel no need spend all their free time telling others about it on the internet all day. I for one feel that were it not for the drug's teratogenicity (toxicity to foetuses), it would not have a fraction of the negative attention that it generates, and would probably even be almost as accessible and prescribable as an antibiotic. It is a great tragedy for so many acne sufferers that they must suffer for years or even never choose to take it under the severe misconception that it will harm them in ways that it almost certainly will not.

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Guest Craigems

I didnt read antony's post but ... i think its more to do with the fact people are mis-informed on accutane. They dont understand that tane causes an initial breakout period... and when people think their acne cant get worse... well ... yeh bang tane kicks in = thoughts of suicide etc. I think that has a lot to do with it... also other aspects include hightened redness in scarring, and baggy eyes and dry lots of dry. I think its more THESE factors rather than the drug messing with your chemical brain functions. I mean if there was a world without mirrors... no-one personally would care about acne, mirrors are a demoic creation in terms of vanity.

Anyways thats my 2 cents... it seems logical.

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