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Overview of Existing Research and Information Linking Isotretinoin (Accutane), Depression, Psychosis, and Suicide

O'Donnell, James

American Journal of Therapeutics: March/April 2003 - Volume 10 - Issue 2 - pp 148-159
Therapeutic Sounding Board

Isotretinoin (Accutane; Hoffmann-La Roche, Nutley, NJ) is a drug closely related to the chemical structure of vitamin A. The pharmacology and toxicology of these two retinoids are similar enough to warrant comparison. Accutane is a powerful drug that its manufacturer, Roche, indicates is limited for severe recalcitrant nodular acne. This potency is also reflected in Accutane's well-known ability to produce severe birth defects if taken during pregnancy. Less well known is the risk of this lipid-soluble chemical to affect the central nervous system. Reports of intracranial hypertension, depression, and suicidal ideation with Accutane use have prompted an examination of its serious and life-threatening potential. Although Roche has added a warning to its product label for signs of depression, and suicidal ideation, this product is overprescribed for all forms of acne, including mild and moderate cases that have not been treated with alternative medications with less risk of depression and suicide. There is no contesting that this drug is effective at clearing up the most severe forms of acne, but the public must be informed of the proper limited indication for its use, because depression and suicide can follow in patients with no prior history of psychiatric symptoms or suicide attempts.

Department of Pharmacology, Rush Medical College, Chicago, Illinois

Address for correspondence: 1935 S. Plum Grove #225, Palatine, IL 60067. E-mail:

Presented in part to the Hearing before the Committee on Government Reform, House of Representatives, One Hundred Sixth Congress, Second Session, December 5, 2000, Serial No. 106–248. Accutane: Is This Acne Drug Treatment Linked to Depression and Suicide? The author is an expert witness in Accutane personal injury suits against Hoffman-La Roche.

© 2003 Lippincott Williams & Wilkins, Inc.