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Your teenager has serious acne, and the dermatologist has recommended Accutane® (isotretinoin), the toughest acne-fighting weapon there is. You've heard that Accutane may be linked to depression, suicidal thoughts and suicide. You wonder if your child should be on this drug.
Accutane treats inflammatory acne known as nodular or cystic acne. Many dermatologists prescribe it as a last resort because it is a potent drug, widely known to cause birth defects. Since 1998 Accutane has also carried a label warning about possible psychological side effects, such as depression, suicidal thoughts or mood disorders.
Patients should not become pregnant during treatment with Accutane because the drug has an extremely high risk of birth defects. iPledge® is a Food and Drug Administration-approved program to reduce the risk of birth defects from Accutane. It requires a female of child-bearing age to be on birth control and to have pregnancy tests 1 month before, during and 1 month after taking the drug. Pharmacies and wholesalers must be registered with iPledge to sell the medication and must check iPledge registration of anyone before filling a prescription for it.
Doctors more cautious
If your teenager seems depressed or is clinically diagnosed as suffering from depression, talk with your health care provider. Some dermatologists say the reports linking Accutane and depression have prompted them to take "a more cautious approach," says Rebecca Baxt, a dermatologist in Paramus, N.J.
"I certainly wouldn't put anybody who suffers from depression on Accutane," Baxt says. If a patient developed indications of depression while on it, she says, "that would be a sign to stop the drug."
Dermatologist Bruce E. Katz, M.D., who is director of the JUVA Skin and Laser Center in N.Y., says he's had only one or two patients complain of depression while on Accutane. Those patients, typical of others who experienced depression while taking Accutane, reported that their symptoms subsided when they stopped taking the drug.
Both dermatologists say they counsel and question patients extensively before prescribing Accutane. If a patient has a history of depression, Katz says he consults with the person's psychiatrist or physician to determine if the acne medication would make the depression worse. He says he would even be reluctant to prescribe Accutane for a teenager who seemed depressed.
Is it the Accutane or the acne?
The problem is that acne might be the source of the teen's depression, Katz says.
"Teens are very unhappy about their skin, and they may be depressed about their skin. Sometimes Accutane can reverse their unhappiness," says Katz, who is also director of the Cosmetic Surgery and Laser Clinic at Columbia Presbyterian Medical Center in N.Y. and clinical professor at the College of Physicians and Surgeons of Columbia University.
If your teenager is 18, he or she must sign an extensive consent form in order to use Accutane. If your child is younger, you must sign the form, which says Accutane is a "very powerful medicine with the potential for serious adverse effects."
What you should know
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD) says you and your teenager should carefully consider the disadvantages of Accutane. In addition to being linked to birth defects, it can cause other side effects, such as:
- Inflammation of the lip and mucous membrane of the eye
- Dry mouth, nose or skin
- Itching
- Nosebleeds
- Muscle aches
- Photosensitivity, and rarely, decreased night vision
Other more serious side effects include increased blood cholesterol, lipid and triglyceride levels and abnormal liver enzymes, according to the NIAMSD. Because of those side effects, doctors usually do periodic blood tests as a way of monitoring a patient.
"Serious side effects from Accutane are very low in patients who are monitored properly and on the right dosage," Katz says. Dry lips are sometimes the worst symptom patients will have, he adds.
If your teenager becomes depressed or has other side effects, tell the doctor immediately. Katz says a doctor might first cut back on the dosage of Accutane to see if that helps. If it doesn't, then the drug should be discontinued.
"It's still the most potent medicine that will often clear acne when nothing else will," Katz says. "People can do extremely well on it."
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External Sources
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The American Academy of Dermatology
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The U.S. Food and Drug Administration
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This article was reviewed and updated June 2007.
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