What is Accutane?
Accutane is the brand name for the drug "isotretinion”. There is no generic version of Accutane available.
All isotretinoin sold in the United States is sold as Accutane. The medication belongs to a class of drugs known as retinoid medications. Retinoid medications are related chemically to Vitamin A and many of the Accutane side effects of this class of medications resemble Vitamin A overdose side effects.
Accutane works by inhibiting or reducing sebaceous gland function. Exactly how it does this is not understood. The reduction of sebum secretion is temporary and depends on the dose and duration of treatment. Accutane treatment usually lasts for 15 to 20 weeks. In many cases, Accutane results in a complete or prolonged acne remission.
Accutane has serious and potentially life-threatening side effects, including birth defects, depression leading to suicide, kidney failure, heart problems, and death. Because of these potentially serious complications, doctors are advised to weigh any potential benefits of the drug against the possible risks. Accutane is a "last choice" treatment, reserved for patients who have not responded to conventional therapies, including antibiotics.
Accutane is sold in soft capsules in doses of 10mg, 20mg, or 40mg. It is the only treatment known to stop severe nodular acne.
Relation to depression and suicide
According to the FDA, Accutane may cause depression, psychosis and, rarely, suicidal ideation, suicide attempts and suicide. Discontinuation of Accutane therapy may be insufficient; further evaluation may be necessary. No mechanism of action has been established for these events
Pseudotumor Cerebri is also listed by the FDA as having Accutane use associated with a number of cases of pseudotumor cerebri (benign intracranial hypertension), some of which involved concomitant use of tetracyclines. Concomitant treatment with tetracyclines should therefore be avoided. Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea and vomiting, and visual disturbances. Patients with these symptoms should be screened for papilledema and, if present, they should be told to discontinue Accutane immediately and be referred to a neurologist for further diagnosis and care.
Depression and suicidal tendencies are two important psychiatric conditions that may be observed in dermatology and family practice settings. This brochure provides an overview of depression, because depression is the most commonly reported psychiatric adverse event in patients taking Accutane, and is also a well-established risk factor for suicidal behavior.
Depression is characterized by symptoms including intense, persistent sadness; anxiety; loss of pleasure from usual activities; and loss of energy. (National Institute of Mental Health. Depression.) These feelings can be normal responses to a negative life event, but clinical depression is either not triggered by such an event or is disproportional to the trigger. Berkow R, Beers MH, Fletcher AJ, Bogin RM, eds. The Merck Manual of Medical Information: Home Edition. Sec. 7, Ch 84. Depression and Mania.
Depression can be episodic. According to the National Comorbidity Survey, 17% of Americans will experience depression at some point during their lives and 5% are depressed in any given month. (. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8-19. Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry. 1994:151:979-986.)
Several epidemiological studies reported that up to 8.3% of adolescents in the United States suffer from depression.
Depression can take several forms; three of the most common are dysthymia, major depression, and bipolar disorder. (National Institute of Mental Health. Depression.) These three disorders are characterized by various combinations of the symptoms listed in Table 1. Not every patient exhibits all depressive symptoms. Some patients, especially adolescents, may display irritability instead of sadness.
Symptoms of Depression
Adapted from National Institute of Mental Health. Depression. Available at: http://www.nimh.nih.gov/publicat/depression.cfm
. As of 4/24/01.
Symptoms of Mania (National Institute of Mental Health (NIMH))
- Persistent sadness, anxiety or feeling of emptiness
- Feelings of guilt, worthlessness or helplessness
- Loss of pleasure from activities that were once enjoyable
- Loss of energy
- Difficulty concentrating or making decisions
- Change in sleep pattern
- Change in appetite
- Physical problems that do not respond to treatment
Suicide accounts for more than 30,000 American deaths each year. It is the third leading cause of death (after accidents and homicide) among people aged 15 to 24, which makes it responsible for more deaths in this age group than any physical illness.(Zaph R II. Adolescent suicide attempts. Available at: Penn State University and National Institute of Mental Health. Suicide facts.)
- Excessive elation
- Increased energy and sexual desire
- Decreased need for sleep
- Racing thoughts and impaired judgment
- Increased talking
- Inappropriate behavior
Healthcare providers often miss the warning signs because patients may hide suicidal intent very successfully. In fact, 60% of people who commit suicide had seen a physician within 1 month of their deaths. (Jacobs DG, Deutsch NL. Recognizing suicide potential in women. Women’s Health in Primary Care.) Suicidal tendencies rarely arise spontaneously; 93% of people who commit suicide suffer from depression, schizophrenia and/or substance abuse. (Goodwin FK, Runck BL. Suicide intervention. In: Jacobs D, ed. Suicide and Clinical Practice. Washington, DC: American Psychiatric Press; 1992:1-21.)
Up to 60% of adolescents and young adults think about suicide at some point,7 but fortunately these thoughts usually pass. Few people who have suicidal thoughts make the attempt, and most attempts at suicide are unsuccessful.(National Institute of Mental Health. Suicide facts). An analysis of completed suicides showed the following common characteristics: (National Depression Screening Day® primary care outreach. Diagnostic Aid for Depression in the Primary Care Setting.)
Ideation (thoughts of death or suicide)
Plan (specific time, place and method)
Means (e.g., a firearm in the house or a supply of drugs)
Women are twice as likely as men to attempt suicide, but men are four times more likely to be successful. Women usually use means from which they may be rescued, such as a drug overdose, Screening for suicide risk. Guide to Clinical Preventive Services, 2nd ed. Mental Disorders and Substance Abuse.) whereas men tend to use firearms or automobiles. Firearms are used in 58% of all completed suicides. (National Institute of Mental Health. Suicide facts).
Despite a patient’s attempt to hide suicidal thoughts, he or she may send deliberate warning signals, some of which can be explicit. (National Institute of Mental Health. Depression) Every mention or discussion of "killing myself" should be treated with utmost seriousness.