Therapeutic ReviewsPolar Hysteria: An Expression of Hypervitaminosis AO’Donnell, James*Author Information Department of Pharmacology, Rush University Medical Center, Chicago, Illinois; and Pharmaconsultant, Inc., Palatine, Illinois. *Address for correspondence: Pharmaconsultant, Inc., 1935 South Plum Grove Road, PMB 255, Palatine, IL 60067. E-mail: JOdonn1935@aol.com American Journal of Therapeutics: November-December 2004 - Volume 11 - Issue 6 - p 507-516 doi: 10.1097/01.mjt.0000123408.73790.d1 Buy Metrics Abstract Isotretinoin (Accutane) is a drug closely related to the chemical structure of Vitamin A. The pharmacology and toxicology of these two retinoids is similar enough to warrant comparison. Accutane is a powerful drug which 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 indeation with Accutane use have prompted an examination of this serious and life threatening potential. Though Roche has added a warning to its product label for signs of depression and suicidal ideation, this product is being overprescribed for all forms of acne, including mild cases and moderate acne that have not been treated with alternative medications, which have a lesser 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 its proper, limited indication for use; depression and suicide can follow in patients with no prior history of psychiatric symptoms or suicide attempts. © 2004 Lippincott Williams & Wilkins, Inc.