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November 18, 2009
Accutane, generic name Isotretinoin, is a product that is used on severe acne that has not cleared with other products, that has been present for a long time, or that has scarred the body. It is a relatively quick-to-work medication (usually taking 5 to 6 months). This product is used as a last resort for acne treatment and should not be used if a woman plans to get pregnant because it has been known to cause birth defects. There have been links between Accutane and mental depression among teenagers sometimes leading to suicide.
This article reviews studies both proving and disproving the claim that Accutane causes depression. Although there are legitimate cases that prove and disprove the theory that Accutane causes depression, the simple fact is that teenagers using Accutane are more prone to depression because of their low self-esteem and Accutane emphasizes this insecurity by decreasing the serotonin levels.
Accutane: The Culprit for Depression?
Since it is a form of Vitamin A, Accutane reduces the amount of oil released by the oil glands in the skin and in turn helps the skin renew itself more quickly. Sometimes after the patient discontinues use of Accutane, these glands swell back up causing acne to return, but most of the time the outbreaks are both less severe and less frequent. Women should use two forms of birth control on the drug because of its effect on pregnancies—major birth defects. As always, there are side effects with prescriptive drugs, and with Accutane there have been reports of major ones. Accutane has been blamed for causing adolescent depression. It does, however, list depression as one of its side effects, along with many other effects. (http://www.naturalessentials.com/accutane.htm)
Teendepression.org, in an attempt to help the teen population and inform the general public about the severity of teen depression, says that 20% of teens will experience depression before reaching adulthood. (http://www.teendepression.org/articles5.html) The University of Pittsburg Medical Center website, which includes general information on all sorts of illnesses and medications, says that 4% of teens on Accutane experience depression. (http://www.upmc.com/HealthAtoZ/Pages/HealthLibrary.aspx?chunkiid=31111) A study in Norway, recorded in Time magazine, says that teenagers with symptoms of depression and low self-esteem were more likely to get acne, which in turn would cause people to link acne and depression together. These teens with severe acne, who, according to this study already have a proneness to depression, will end up using products such as Accutane. (http://www.timeinc8-sd11.websys.aol.com/time/health/article/0,8599,1924464,00.html) Therefore, a link can usually be found between these two things.
Studies that Prove the Link between Accutane and Depression
In a study done by the Department of Dermatology at the Churchill Hospital in Oxford, England, in the British Journal of Dermatology, the quality of life was studied in patients with acne and in patients with chronic diseases. The Department tried to figure out the connection between the two to better help their patients. The quality of life was measured using different scales; one was called the “Dermatology Life Quality Index”, one was called Rosenberg’s measure of self-esteem, and one was a modified form of the General Health Questionnaire (which is “a tool used to assess symptoms of neurosis in patients with mental health problems” as defined by encyclopedia.com) and the Short Form (which measures physical and mental well-being through 36 questions). The reported quality of life measuring “levels of social, psychological and emotional problems” in patients with acne was about the same as in patients with chronic diseases. (http://www.ncbi.nlm.nih.gov/pubmed/10233319) Acne can have severe effects on people causing them to feel horrible about themselves.
A Congressional Representative from Michigan, Bart Stupak, had a son who killed himself while on the Accutane medication and the Representative tried to establish holds on the drug because he believed that it was the drug that caused his son’s death. In an article by Steve Mitchell, who reports the Representative’s initiative, the Representative even says that although the released number of suicides while taking the drug has only been 200, the FDA has withheld documents that suggest this number is really only 1% of the official count. This would mean that there could have been up to 20, 000 suicides while on the medication. Although the FDA has altered the records increasing the amount of suicides, the FDA has released records saying that thousands have experienced psychological changes while on the drug. (http://www.rense.com/general32/scu.htm)
In Section 1 of the graph, the percentage of teenagers on Accutane experiencing depression is shown next to the percentage of teenagers in general experiencing depression. It is the 4% compared to the overall 20%. In Section 2 of the graph, the numbers put forth by the representative from Michigan are shown (on a much smaller scale). The number of reported cases is set at 2 (100 times smaller than the actual amount of 200) and the number apparently withheld by the FDA is set at 200 (100 times smaller than the “actual” number of 20,000).
Swedish.org reports that it is a known truth that acne has severe impacts on a person’s outlook on life. It can cause him “social withdrawal, decreased self-esteem, reduced self-confidence, poor body image, embarrassment, feelings of depression, anger, preoccupation, frustration, and a higher rate of unemployment.” (http://www.swedish.org/16648.cfm) All of these things cause major stress to people experiencing them and cause them to feel bad about themselves and cause them to not want to do anything, hence the depression. Scientists from the University of Texas at Austin and the University of Bath in England did a study on the effects of Accutane and discovered that it does have an effect on one’s mental state. There were two sets of mice—one set injected with an amount of Accutane comparable to that of a human dosage and one set not injected with the drug. The test was done over a period of six weeks. They used two stress tests on mice; one test involved holding the mice upside down by the tail, and the other involved placing the mice into a pool of water. These studies were meant to show how the mice injected with a dose of Accutane reacted as opposed to those not injected. They found that the group injected with Accutane was a lot more motionless when put into stressful situations than the group that was not injected. They didn’t move as much as the other mice did. The team also found that Accutane is in a group known as the retinoids which affects the development of the nervous system. This is why Accutane is not prescribed to pregnant women. However, new evidence implies that retinoids can affect the adult human brain as well and cause the mental system to be altered. (http://www.utexas.edu/news/2006/09/21/human_ecology/)
Studies that Disprove the Link between Accutane and Depression
Although the study with the mice seems to imply that Accutane in fact could cause depression in teens using the drug, there are many studies that disprove this and even claim that Accutane decreases feelings of depression in teens. Through a study at the Department of Dermatology in Turkey, scientists found no connection between Accutane and depression. The study used 50 patients with mild to severe acne and then 30 patients with clear skin and they evaluated the anxiety levels and depressive symptoms at 0,1, and 4 months. The patients on the medication showed severe improvement in depressive symptoms and later improvement in anxiety. (http://www.ncbi.nlm.nih.gov/pubmed/19701845?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)
On sexualhealth.com, looking to promote knowledge of different subjects, a team of researchers found that Accutane actually decreased the level of depression in teens. They measured depression on a scale called the Center for Epidemiological Studies Depression Scale. At the beginning of the 3-4 month test, 14% of the group using Accutane showed signs of depression (according to the test); by the end of the 4 month trial, only 8% registered as depressed. This in fact indicated that the drug Accutane lowered the levels of depression in the lives of those using the drug. (http://www.sexualhealth.e-healthsource.com/?p=news1&id=525738)
Puberty and body image are such hard things to conquer; therefore many teens feel bad about themselves and are more prone to depression. Parents are so quick to blame something because surely it’s not their child’s fault that he has depression. Children at the age of pre-teen and teen have acne—FACT OF LIFE. Whether or not the proneness to depression causes the child to have acne, or the acne causes the child to have depression is unknown. However, there is no doubt that the Accutane, while closing off oil glands and decreasing serotonin levels, definitely emphasizes the insecurities that these teenagers have because it alters the balance of chemicals present in the body. Also, sudden changes in serotonin levels in the brain can lead to severe mood changes which can be linked to depression.
Because the people prescribed Accutane happen to be the age at which depression occurs most frequently, Accutane is often blamed for the depression. If a teenager looks better (clearer skin) then he should feel better about himself (and not be depressed). Teens that have bad skin and lower self esteem are more likely to experience depression than other teenagers. Almost every year there have been reports of Accutane linkages to depression since 1982 (when the drug was approved by the FDA). Because only 200 reported cases of successful suicides exist, more studies are needed because evidence is not adequate to prove Accutane is the culprit for depression among teenagers taking the medication. There are cases that imply a connection between the drug and depression (the UT Austin/Bath study) and there are cases that disprove the connection (The Department of Dermatology in Turkey). With this said, it is evident that Accutane users do experience psychological changes, but the people using the drug are more prone to depression anyway. Already experiencing low self-esteem, Accutane decreases serotonin levels and emphasizes the insecurities of the teenagers.
“Accutane and Depression: Is There a Link?” University of Pittsburg Medical Center. 30 September 2009. <http://www.upmc.com/HealthAtoZ/Pages/HealthLibrary.aspx?chunkiid=31111>.
Bozdağ KE, Gulseren S, Guven F, Cam B. “Evaluation of depressive symptoms in acne patients treated with isotretinoin.” January 2009. 29 September 2009. <http://www.ncbi.nlm.nih.gov/pubmed/19701845?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum >.
Chung, Sue. “The Pros and Cons of Accutane.” MySkinCareConnection.com. 9 November 2007. <http://www.healthcentral.com/skin-care/c/38641/16137/pros-cons/ >.
Cloud, John. “Teen Acne and Depression: Can Mood Worsen Skin?” Time. 17 September 2009. <http://timeinc8-sd11.websys.aol.com/time/health/article/0,8599,1924464,00.html>.
“Definition of Serotonin.” MedicineNet.com. 5 November 2003. <http://www.medterms.com/script/main/art.asp?articlekey=5468>.
Mallon, E. “The Quality of Life in Acne: A comparison with general medical conditions using questionnaires.” The British Journal of Dermatology. April 1999. <http://www.ncbi.nlm.nih.gov/pubmed/10233319>.
Mitchell, Steve. “Congressional Committee Finds Accutane Causes Suicide.” 12 December 2002: 30 September 2009. <http://www.rense.com/general32/scu.htm>.
Reinberg, Steven. “Study: Acne Treatment Won’t Trigger Depression.” Healthday. 16 May 2008. <http://www.sexualhealth.e-healthsource.com/?p=news1&id=525738>.
“Scientists find popular acne drug leads to depression-related behavior in mice.” 21 September 2006. <http://www.utexas.edu/news/2006/09/21/human_ecology/>.
Teen Depression. “Teen Depression Statistics.” 2005: September 30, 2009. <http://www.teendepression.org/articles5.html>.
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