Study on Acne Suicide Risk Fuels Debate Over Drugs

Peoplewithsevereacneareatincreasedriskofattemptingsuicide,scientistssaidonFridayinastudy,whichfuelsadebateaboutwhetheracnedrugssuchasRoche'sAccutanepromptsuicidalthoughts.

Swedishscientistsfoundpatientshadanadditionalsuicideriskforuptoayearaftertreatmentwithisotretinoin,thegenericversionofAccutane,whichiscommonlyprescribedforpeoplewithsevereacne.

"Amoreprobableinterpretationisthattheunderlyingsevereacnemaybestexplaintheraisedrisk,"theysaid,althoughtheycouldnotruleoutthatitmaybe"asaconsequenceofexposuretothedrug."

Accutane,whichSwissdrugmakerRochesaidlastyearitwouldstopsellingbecauseofgenericcompetition,hashadacontroversialhistorysinceits1982launch.

Whilepowerfulatclearingacne,thedrughasbeenlinkedtobirthdefectsiftakenduringpregnancyandhasalsobeensuspectedofcausingmentalsideeffects,althoughRochehasvigorouslydefendedpersonalinjuryclaimsinthisarea.

ItisnowavailableasgenericisotretinoinandsoldbydrugmakersincludingMylan,RanbaxyandTevaPharmaceuticalIndustries.

Acneisawidespreadskincomplaintfoundinupto80percentofadolescents.Whilemostcasesaremild,moreseverecasescanbequitedisfiguring,asensitiveprobleminsocialgroupsoftenalreadyselfconsciousabouttheirbodies.

Doctorssayisotretinoiniseffectiveinpatientswithsevereacne,butalsonotereportslinkingisotretinointodepressionandsuicidalbehavior.Scientificstudieshavehadconflictingresults.

AstudybyCanadianscientistspublishedintheJournalofClinicalPsychiatryin2008suggestedisotretinoinmightdoubletheriskofdevelopingdepression.

ANorwegianstudyearlierthisyearfoundthatlevelsofdepressionandsuicidalthoughtsweretwoorthreetimeshigherinyoungpeoplewhohadthemostsevereacnethaninthosewithoutit,suggestingthedrugtreatmentmaynotbetoblame.

NaturalCourse?

Againstthisbackground,AndersSundstromandateamfromtheKarolinskaInstituteinSwedeninvestigatedsuicideattemptsbefore,duringandafterisotretinointreatmentforsevereacne.

Theyassesseddatafrom5,756peoplewhohadbeenprescribedisotretinoinfrom1980-89andlinkedthesetohospitaldischargeandcauseofdeathregistersfrom1980-2001.

Theresults,publishedintheBritishMedicalJournal,found128patientsadmittedtohospitalafterasuicideattempt.Thestudyalsofoundthenumberofsuicideattemptsrosebetweenoneandthreeyearsbeforestartingtotakeisotretinoin.

Theriskswerehighestwithinsixmonthsoftreatmentending.

Sundstrom'steamsaiditwasimpossibletosayforcertainwhetherthecontinuedriseinsuicideriskwas"duetothenaturalcourseofsevereacne,ortonegativeeffectsofthetreatment."

Commentingonthestudy,SarahBaileyofthepharmacyandpharmacologydepartmentatBritain'sBathUniversitysaiditwasimportantresearchwhichstrengthenstheviewthatacneitselfcanhavesignificantpsychologicaleffects.

"Thecontroversialissueofincreasedsuicideriskwithisotretinoinuseisnotresolvedbythispaper,"shesaid,addingthatthemostinterestingfindingwasthattheriskofsuicideisincreasedaftertreatment,showingthatitis"essentialtocontinuetomonitorpatientscarefully."