Is Accutane actually safe for teenagers with a history of depression and anxiety?

Question

My 16 year old son has struggled with moderate/severe acne for 2 yrs. The older he gets, the worse it gets. He uses 2 topicals and has used oral antibiotics for about a year but his doctor will not prescribe antibiotics anymore. She is pushing for accutane but this worries me. When he was 10-13 he was diagnosed with depression and anxiety. Through therapy he is much improved. Accutane is rumored to cause suicidal tendencies. Should I be concerned? Please help. Thank you

Estee Williams, MD · Answer

Whether isotretinoin causes or unmasks psychiatric symptoms, including depression or suicidal thoughts, is considered controversial in my opinion.  Even if there were no link scientifically, you personally might believe there is, were his depression to return, and feel guilty.Given that, the best way to approach your son's case would be to have the clinician who diagnosed him with depression/anxiety (was it a psychiatrist?) and treated him (was a therapist involved?) speak directly to the dermatologist.  If his depression/anxiety were severe, then that would be a different story from a short, mild episode. I would think how you would feel if his old symptoms came back. I would consider if his current acne is also a risk for making him feel depressed. You need to weigh the risks and benefits and be prepared for that possibility. So while his history (as you wrote it) is NOT a contraindication, he needs a team-approach, to be monitored closely, and it would be important to keep start low and increase slowly.

Michael A. Greenberg, MD · Answer

I have used Accutane for over thirty years and have not seen depression from it.  I have had many patients on it with the same history as your son with no problems or worries.The stories of depression that go around the Internet are, in my opinion, just that, starting with a politician whose son had issues and, tragically, committed suicide and the parents are looking for any excuse they can to understand what happened.You should always be concerned with a teenager with depression and anxiety and there are teens who unfortunately end their lives who are not on Accutane.Talk to your doctor about it but I would proceed -- having severe acne by itself in teens is a major reason for depression and anxiety.

Alim R. Devani, MD, FRCPC · Answer

For your child, I think a low dose accutane is the best way to go. I tend to start 10-20 mg daily to every other day for kids who are stable but have some risk with depression. Any kid with suicide thoughts or tendencies will not get accutane. I believe that the depression and accutane link is dose depandant and low dose treatment would be safe.

F. Victor Rueckl, MD (in memoriam) · Answer

Accutane is not a mood altering drug. For about 20 years we prescribed it and it had zero notifications or listings with depression. Then a member of Congress had a child who took Accutane and committed suicide. And then voila! all the hoopla and postings show up. In my opinion, 1. many people with acne and bad skin are depressed, because they don't feel like they look good or fit in, and 2. many teenagers in general are depressed due to hormone changes. So, I don't see any reason why your son cannot use Accutane, as long as he continues his other therapies, and maybe, just takes a very low dosage for a longer amount of time. The issue with Accutane is getting to a total cumulative dose of 8000-16000mg total and it doesn't matter if you do that in 6 months or 2 years' time. So have him take a lower dosage and then just have him continue all other meds. And also, discuss it with his other physicians who are managing his depression. "This
answer has been solicited without seeing this patient and cannot be
held as true medical advice, but only opinion. Seek in-person treatment
with a trained medical professional for appropriate care."

Is Accutane actually safe for teenagers with a history of depression and anxiety?

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