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Accutane Side Effects: Should Depression Be A Concern?
Medical professionals and acne-pestered adolescents have no
doubts about the effectiveness of the severe acne drug
isotretinoin. It's the looming possibility of side effects such as
depression and fetal damage that makes people uneasy when
considering using this medication.
Accutane (isotretinoin) is one of Hoffman-LaRoche's most popular
and controversial pharmaceuticals. This week, a study published in
the Archives of Dermatology vindicated isotretinoin from causing
depression. In this report, Christina Y. Chia, MD, from Saint Louis
University Health Sciences Center, St. Louis, and colleagues
examined whether patients with moderate to severe acne treated with
isotretinoin experienced an increase in depressive symptoms
compared with patients treated with a topical antibiotic, topical
retinoid, and an oral antibiotic.
Dr. Chia found that "The use of isotretinoin in the treatment of
moderate-severe acne in adolescents did not increase depressive
symptoms. On the contrary, our study shows that treatment of acne
improves depressive symptoms".
Five years earlier, in 2000, the isotretinoin-depression link
still appeared misleading. That time, the Archives of Dermatology
posted study, headed by Dr. Susan S. Jick, from the Boston
University School of Medicine, which found no evidence that
isotretinoin increases the risk for depression, suicide, or other
psychiatric disorders.
Even though isotretinoin finds ample support among
dermatologists and psychiatrists, a host of parents, politicians
and medical professionals hail isotretinoin as a medical
misfortune. For instance, Dr. David J. Graham, the Associate
Director for Science and Medicine in FDA's Office of Drug Safety,
recently warned that Accutane should be taken off the market.
And while there are few studies with any negative observations
about isotretinoin, Dr. Douglas Bremner's research at of the Emory
University School of Medicine has linked isotretinoin treatment
with changes in brain function. At the conclusion of this study,
published in the American Journal of Psychiatry, Dr. Bremner
concurred with Dr. Graham's view that isotretinoin proves too
dangerous for human use.
Dr. Bremner explains that to invoke depression, isotretinoin
must influence the brain. During the investigation, brain function
of the subjects was measured using positron emission tomography
(PET) before and after four months of treatment with isotretinoin.
Isotretinoin treatment was associated with decreased brain
metabolism in the orbitofrontal cortex- the area of the brain known
to mediate symptoms of depression. Yet, there were no differences
in severity of depressive symptoms between the isotretinoin and
antibiotic treatment groups before or after treatment.
The pessimistic effects of isotretinoin also caught the
attention of Diane K. Wysowski PhD. Dr. Wysowski noted that in June
2000, isotretinoin ranked among the top 10 drugs linked to
depression and suicide attempts in the FDA's Adverse Event
Reporting System database. In 2001, Dr. Wysowski examined
isotretinoin's depression inducing potential and posted her
findings in the Journal of the American Academy of Dermatology.
Dr. Wysowski concluded that more studies of isotretinoin are
needed. She also advised patients and their parents to immediately
report mood swings and symptoms that are suggestive of depression
such as sadness, crying, loss of appetite, unusual fatigue,
withdrawal, and inability to concentrate to their prescribing
physician. These protective measures can avoid more serious side
effects and permit appropriate treatment, including consideration
of drug discontinuation and referral for psychiatric care.
While dissension among researchers still exists about whether or
not isotretinoin causes depression, one idea most of them can agree
on is that more research on the side effects of isotretinoin are
desirable. If you are not in the mood for being an isotretinoin
guinea pig, Geoffrey Redmond MD, author of The Good News about
Women's Hormones, suggests using hormone therapy and/or using
Retin-A if isotretinoin seems too chancy for you.
Health author and Stanford University graduate Naweko San-Joyz
lovingly writes from her home in San Diego. Her works include "Acne
Messages: Crack the code of your zits and say goodbye to acne"
(ISBN: 0974912204) and the upcoming work "Skinny Fat Chicks, Why
we're still not getting this dieting thing" (ISBN: 0974912212) for
release in June of 2005. For useful acne self-help articles visit
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