Medical professionals and acne-pestered adolescents have no doubts about
effectiveness of severe acne drug isotretinoin. It’s 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 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 treatment of moderate-severe acne in adolescents did not increase depressive symptoms. On contrary, our study shows that treatment of acne improves depressive symptoms”.
Five years earlier, in 2000, isotretinoin-depression link still appeared misleading. That time, Archives of Dermatology posted study, headed by Dr. Susan S. Jick, from Boston University School of Medicine, which found no evidence that isotretinoin increases 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, Associate Director for Science and Medicine in FDA’s Office of Drug Safety, recently warned that Accutane should be taken off market. And while there are few studies with any negative observations about isotretinoin, Dr. Douglas Bremner’s research at of Emory University School of Medicine has linked isotretinoin treatment with changes in brain function. At conclusion of this study, published in 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 brain. During investigation, brain function of 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 orbitofrontal cortex- area of brain known to mediate symptoms of depression. Yet, there were no differences in severity of depressive symptoms between isotretinoin and antibiotic treatment groups before or after treatment.
