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Mental risks from Accutane draw attention

Evidence linking the drug to depression and suicidal tendencies remains anecdotal but enough to cause concern.

By Victoria Stagg Elliott, amednews staff. May 6, 2002.

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The woman showed up at the office of Shane Chapman, MD, a dermatologist based in Lebanon, N.H., crying uncontrollably. Just a couple weeks before, she had started taking Accutane and now was extremely unhappy. Dr. Chapman, an assistant professor of medicine at the Dartmouth-Hitchcock Medical Center, told her to stop taking the drug and escorted her to her psychiatrist's office.

Two months later, she returned to Dr. Chapman's office, this time feeling fine -- though still with severe acne. She asked to be put on Accutane again. Dr. Chapman agreed, but only with the approval of her psychiatrist, who would assess her mental condition every two weeks.

"We worked it out because she did have horrible cystic scarring acne which can make you depressed by itself," he said.

But she came back to the office again unable to stop crying. Dr. Chapman again took her off the drug.

Evidence linking Accutane (isotretinoin) to depression and even suicide remains anecdotal. Dr. Chapman says that he has only seen two or three patients out of the thousands to whom he has prescribed it get depressed. None have committed suicide. Moreover, patients get happier as skin clears up.

"I've seen patients who were depressed with their acne," said Stephen Webster, MD, a dermatologist with Gundersen Lutheran Medical Center in La Crosse, Wis. "When the acne cleared up, they became a different individual."

But several high-profile incidents possibly linking the drug with severe depression have moved the question into the spotlight. These events include the suicide of the son of Rep. Bart Stupak (D, Mich.) in May 2000, and the tragedy of the adolescent who flew a small plane into a Tampa, Fla., office building earlier this year. [...]