Dermatologists sometimes recommend the prescription drug Accutane (isotretinoin) for people with difficult-to-treat acne. However, when reading the prescription insert, users will often be baffled to find depression and suicidal thoughts among the safety warnings.
This is an understandable reaction and deserves full disclosure as to the benefits and risks of treatment.
Background of isotretinoin
Isotretinoin is an oral medication used to treat severe acne. It is sometimes used to treat acne which is not necessarily severe, but stubborn and does not go away with other acne medications.
Isotretinoin was initially approved under the brand names Accutane and Roaccutane. Since then, it has been produced by other manufacturers under different names, such as Absorica and Zenatane, and even in the generic form of isotretinoin.
All of these medicines contain the same active substance and all work in the same way. All isotretinoin medicines are prescription only and you must enroll in the iPledge program before you can fill your prescription.
The iPledge program was created to inform consumers that isotretinoin is contraindicated during pregnancy due to the high risk of birth defects. Isotretinoin can only be prescribed for registered users who qualify for the program.
Risk of depression
There is no clear and proven link between isotretinoin and depression. For every study that found a high risk of depression in isotretinoin users, there is another that found no risk. That being said, it appears that isotretinoin poses a risk for depression for a small number of users.
Overall, depression in people taking isotretinoin is quite rare. Depending on the study you are looking at, depression occurs in 1% to 11% of people taking the drug. It does not necessarily mean isotretinoin cause depression.
While isotretinoin-induced depression can affect people without a history of the disorder, many have had pre-existing conditions that put them at risk, including substance abuse, bipolar disorder, or a family history of depression. .
It’s important to remember that just because you take isotretinoin doesn’t mean you will get depressed. Most people who became depressed while taking isotretinoin found that their symptoms went away once they stopped taking the drug. But for some people, depression and suicidal behavior persisted even after they stopped taking the drug.
Although case reports suggest a relationship between isotretinoin use and depression, there is no proven link. Yet some research has presented a few theories.
One theory examines how isotretinoin causes changes in the area of the brain called the hippocampus. The hippocampus is constantly creating neurons, a process called neurogenesis. The formation of neurons in the hippocampus is reduced when taking isotretinoin (at least in mice and rats).This decrease in neurogenesis may be a biological reason for depression while taking isotretinoin.
It is theorized that people in whom neuron formation is already reduced in one way or another may be more susceptible to this decrease in neurogenesis caused by isotretinoin than others. This would explain why some people seem to develop depression while taking isotretinoin while others never do.
Having severe acne can also cause depression and even increase the risk of suicide.
A 2010 study published on BMJ online found that among 5,700 isotretinoin users, the risk of suicide was highest among those who had stopped treatment for six months and lowest among those who were actively taking the drug.
What this suggests is that the return of severe acne (and the prospect of living with the disease for the rest of their lives) was at the heart of the 128 suicide attempts.
Other studies have found no definitive link between isotretinoin and an increased risk of depression.
Use the drug safely
Although isotretinoin has side effects, it is incredibly effective in clearing the most serious inflammatory or cystic acne, even those cases that do not respond to other medications. It is important to weigh the benefits against the risks.
Controlling severe acne not only lowers your chances of developing scars, but can also improve your self-esteem and self-confidence.
If you decide to go ahead with isotretinoin treatment, there is no reason to be anxious. While you (or your child) are taking Accutane, watch for symptoms of depression, such as:
- Changes in mood and behavior
- Feeling unusually sad, angry, irritable or aggressive
- Difficulty concentrating
- Thoughts of suicide or thoughts of hurting yourself
- See or hear things that are not real
Sometimes those closest to you will see changes in your behavior and personality before you notice them yourself. You may want to seek their help and let them know about your treatment so that they can also help you be on the lookout for major changes in your behavior that could signal a problem.