It’s an understandable reaction and one that deserves full disclosure as to the benefits and risks of treatment.
Isotretinoin Background
Isotretinoin is an oral medication that is used to treat severe acne. It is sometimes used to treat acne that isn’t necessarily severe, but stubborn and not clearing up with other acne medications.
Isotretinoin was originally approved under the brand names Accutane and Roaccutane. Since then, it has been produced by other manufacturers under different names, like Absorica and Zenatane, and even as generic isotretinoin.
All of these medications have the same active ingredient and all work in the same way. All isotretinoin medications are prescription only, and you must register in the iPledge program before you may fill your prescription.
Depression Risk
There is no clear, proven link between isotretinoin and depression. For every study that has found a high risk of depression in isotretinoin users, there is another that has found no risk. With that being said, it seems isotretinoin does pose a risk of depression to a small number of users.
All in all, depression in people taking isotretinoin is fairly uncommon. Depending on which study you look at, depression happens in anywhere from 1% to 11% of people taking the medication . This doesn’t necessarily mean the isotretinoin causes depression.
It’s important to remember that just because you’re taking isotretinoin doesn’t mean you will become depressed. Most people who did become depressed while using isotretinoin found that their symptoms went away once they stopped using the drug. But for some people, depression and suicidal behavior persisted even after they quit using the drug.
Theoretical Causes
While case reports suggest a relationship between isotretinoin use and depression, there is no proven link. Still, some research has presented a few theories.
One theory looks at how isotretinoin causes changes in the area of the brain called the hippocampus. The hippocampus creates neurons constantly, a process called neurogenesis. Neuron formation in the hippocampus is reduced while taking isotretinoin (at least in mice and rats). This decrease in neurogenesis may be a biological reason for depression while taking isotretinoin.
It’s theorized that people in which neuron formation is already reduced in some way may be more susceptible to this decrease in neurogenesis caused by isotretinoin than others. That 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.
What this suggests is that the return of severe acne (and the prospect of living with the condition 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.
Using the Drug Safely
Although isotretinoin comes with side effects, it is incredibly effective at clearing the most severe inflammatory or cystic acne, even cases that don’t respond to other medications. It’s important to weigh the benefits against the risks.
Getting severe acne under control not only reduces your chance of developing scarring but can also improve your self-image and self-confidence.
If you decide to go forward with isotretinoin treatment, there’s no reason to be anxious. While you (or your child) is taking Accutane, watch for any symptoms of depression, like:
Changes in mood and behavior Feeling unusually sad, angry, irritable, or aggressive Trouble concentrating Suicidal thoughts, or thoughts of hurting yourself Seeing or hearing things that are not real
Sometimes those closest to you will see changes in your demeanor and personality before you notice them yourself. You may want to enlist their help, and let them know about your treatment so they can also help you be on the watch for major changes in your behavior that might signal a problem.
