Medical professionals and acne-plagued teens have no doubts about the efficacy of the drug isotretinoin for severe acne. It is the looming possibility of side effects such as depression and fetal harm that makes people uncomfortable considering the use of this drug.

Accutane (isotretinoin) is one of the most popular and controversial pharmaceuticals from Hoffman-LaRoche. This week, a study published in the Dermatology Archives isotretinoin claimed to cause depression. In this report, Christina Y. Chia, MD, of the Saint Louis University Health Sciences Center, St. Louis, and her colleagues examined whether patients with moderate to severe acne treated with isotretinoin experienced an increase in symptoms. depressive compared to patients treated with a topical antibiotic. , topical retinoid and 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 acne treatment improves depressive symptoms.”

Five years earlier, in 2000, the relationship between isotretinoin and depression still seemed misleading. That time, the Dermatology Archives A published study, led by Dr. Susan S. Jick of Boston University School of Medicine, found no evidence that isotretinoin increases the risk of depression, suicide, or other psychiatric disorders.

Although isotretinoin finds wide support among dermatologists and psychiatrists, a large number of parents, politicians, and medical professionals hail isotretinoin as a medical disgrace.

For example, Dr. David J. Graham, Associate Director of Science and Medicine in the FDA’s Office of Drug Safety, recently warned that Accutane should be withdrawn from the market.

And while there are few studies with negative observations on isotretinoin, research by Dr. Douglas Bremner at Emory University School of Medicine has linked isotretinoin treatment to changes in brain function. At the conclusion of this study, published in the American Journal of PsychiatryDr. Bremner agreed with Dr. Graham’s opinion that isotretinoin is too dangerous for human use.

Dr. Bremner explains that to invoke depression, isotretinoin must influence the brain. During the investigation, the subjects’ brain function was measured by 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. However, there were no differences in the 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 was ranked in the top 10 drugs associated with depression and suicide attempts in the FDA Adverse Event Reporting System database. In 2001, Dr. Wysowski examined the depression-inducing potential of isotretinoin and published her findings in the Journal of the American Academy of Dermatology.

Dr. Wysowski concluded that more isotretinoin studies are needed. He also advised patients and their parents to report mood swings and symptoms suggestive of depression, such as sadness, crying, loss of appetite, unusual fatigue, withdrawal, and inability to concentrate to their doctor. These protective measures can prevent more serious side effects and allow appropriate treatment, including consideration of drug discontinuation and referral for psychiatric care.

While there is still disagreement among researchers on whether or not isotretinoin causes depression, one idea that most of them may agree on is that further research on the side effects of isotretinoin is desirable. If you’re not in the mood to be a guinea pig on isotretinoin, Geoffrey Redmond MD, author of The good news about female hormones, suggests using hormone therapy and / or using Retin-A if isotretinoin seems too risky for you.