Acne, acne medicine and mental health: Study

By Dr. Ananya Mandal, MDNov 14 2010

Acne drug Accutane (isotretinoin) has been plagued by serious controversies with some linking it to suicidal tendencies. Now the latest research finds that severe acne itself increases the risk for suicidal thoughts and actions, raising more questions about the role of the drug, if any, in suicide.

In the new study authors conclude that use of Accutane for severe acne might lower the overall risk for suicidal behaviours in patients with severe acne, although they concede its use may trigger these behaviours in some vulnerable patients. Researcher Anders Sundstrom said, “The main message is that very bad acne alone increases the risk for suicide attempts, regardless of treatment.”

Accutane has been used by more than 13 million people with severe acne since 1980’s, according to manufacturer Hoffmann-La Roche Inc. It has been linked to serious birth defects and miscarriage. Reports of depression and suicidal behaviours in users appeared thereafter. Severe acne sufferers are commonly prescribed isotretinoin, also known as Roaccutane, Amnesteem, Claravis, Clarus or Decutan.

This latest study appears in the journal BMJ Online First. In this the team followed more than 5,700 patients with severe acne in the years before, during, and up to 15 years after they took Accutane or isotretinoin. The study was carried out at the Karolinska Institute, Sweden between 1980 and 2001.128 patients had to be admitted for a suicide attempt during the study period.

The findings show that the risk for suicide was increased several years before treatment and remained elevated in the months after treatment. In this way the drug could not be implicated wholly write researchers. The highest risk was seen six months after treatment ended, leading the researchers to speculate that patients who aren’t helped by the drug may be distraught at the prospect of having to continue to live with their acne. Surprisingly, taking the drug was associated with a lower risk of a second suicide attempt in patients with a previous attempt. Sundstrom said, “This suggests that a history of suicide attempts may not be a definite cause for avoiding this drug.” He also adds that patients with severe acne may have an increased risk for depression and suicidal behaviours.

A close watch on patients on this treatment is essential they write and the watch needs to be continued up to 1 year after treatment is stopped.

According to Dr. Parker Magin, a senior lecturer at the University of Newcastle in New South Wales, the impact of treatment with isotretinoin on suicidal behaviour may never be fully clear. He said, “It would be difficult, if not impossible, to prove causality without a randomized trial, and we are never going to see that… What we do now know is that acne is not a trivial condition, particularly acne of the severity that would qualify for the use of this drug.”

Dr Sarah Bailey, lecturer in the Department of Pharmacy and Pharmacology at the University of Bath, also said, “This is an important paper that strengthens the view that acne itself can have significant psychological effects and that there is a low risk of suicide for some acne patients…However, the controversial issue of increased suicide risk with isotretinoin use is not resolved by this paper, which the authors themselves acknowledge…Perhaps their most interesting and novel finding is that the risk of suicide is increased AFTER treatment has stopped and therefore it is essential to continue to monitor patients carefully.”