MEDICATION INFO - It's been linked to suicide - but acne drug Roaccutane is still worth trying

It's been linked to suicide - but acne drug Roaccutane is still worth trying

By DR ELLIE CANNON

PUBLISHED: 21:00 GMT, 17 August 2013 | UPDATED: 21:06 GMT, 17 August 2013

Clean skin: Roaccutane is still the doctor's recommendation

Last month, another suicide was reported of a young man linked to acne drug Roaccutane.

James Sillcock, 26, took his own life – but it had been  almost a decade since he gave up the medication.

In a note to his parents, he  said the treatment had left him  ‘in tatters’.

It seems it triggered severe depression.

Just a few weeks earlier, this newspaper reported the case of Michael Bowlby, 16, a boarder at Cheltenham College, whose doctor was not alerted when the boy started to have terrible mood swings while on the medication.

Again, he took his own life.

Looked at in isolation, it might seem this was a dangerous drug that should not be prescribed.

But while these cases are horrific, I regularly refer patients for this very treatment – and call for parents, and adults who take it, not to be alarmed.

How can a drug that makes healthy people depressed and suicidal be called safe?

The association between Roaccutane – also called isotretonin – and depression is widely talked about, and clinicians are very aware of the issue. 

But despite the cases reported, no scientific studies have been able  to prove that Roaccutane causes psychiatric changes,  or suicidal thoughts.

There are studies that show a link, but studies have  not proven that the medicine actually causes the depression.

That seems like a total  cop-out. These boys were perfectly fine, then took pills and developed mental illness. Isn’t the cause obvious?

Not at all. We don’t truly  know what causes depression – although adverse life events or stress do play a huge role. One cannot underestimate the impact that acne itself has on a patient’s self-esteem. Severity is completely subjective – one person might be not in the least bothered by bad spots, while another might feel deeply unhappy about what seems a mild problem. It is always difficult to separate changes in mood caused by the drug and those caused by the condition.

But mental health problems are a recognised side effect?

Yes, mental health problems are listed as a rare side effect – although pre-existing illness is not a reason not to give it to a patient. Manufacturers advise that the possibility of a link should be considered before treatment.

If psychiatric changes occur during treatment, the drug should be stopped, the prescriber informed, and specialist psychiatric advice should be sought.

Recommended help: Roaccutane is used to treat skin conditions such as rosacea and acne

I have read it was banned in the US, but it’s still given out here. Why is this the case?

In 2009, manufacturer Roche decided to withdraw the drug from the US but the drug remains licensed for prescription on the NHS. Roche were sued by a  well-known American actor who claimed the drug had caused him to have bowel disease. Gut problems can be a side effect of many drugs, but his case was particularly bad and he won. Roche removed the drug from market to prevent further costly litigation.

Now you’re saying it  causes bowel disease?

All drugs have side effects – even old familiars such as paracetamol, which can cause irreversible liver damage. That is why the leaflet in the box has such a long list of side effects, although most people won’t suffer any at all. You have to be aware with all medicine that adverse effects are possible. The bowel disease was a rare side effect that doesn’t happen to most people. Withdrawing it in the United States was clearly a commercial decision.

Why does a drug for the skin affect the mood?

 We don’t know. The drug is similar to Vitamin A, and there is no scientific hypothesis as to why this would cause suicidal thoughts. It can be prescribed only by a dermatologist, and patients are scrutinised carefully to assess their mental health.

If there is a risk, no matter how small, isn’t it best to avoid the drug?

Although it’s not a ‘last resort’, it is an exceedingly effective drug for acne.

I have seen hundreds of patients have their lives completely turned around by it with a huge improvement in their skin. For them, the result is a vast improvement in mood and self-esteem.

Acne is not merely a  ‘skin’ condition: it is a very visible problem and affects everything from relationships to job prospects. Acne sufferers are often desperate for help, and dermatologists have to weigh up the balance of risks and benefits.

For the vast majority of patients, the improvement is significant and the side effects minimal.