Accutane May Be Linked To Suicide Risk: Study
4 CommentsBy Ed Silverman // November 12th, 2010 // 10:41 am
Whether the Accutane acne med is capable of causing someone to attempt suicide has been a long-standing debate. Severe acne, after all, is known to be very disturbing, suggesting some Accutane patients may already be disposed to consider suicide. Yet a sure-fire scientific link has been lacking. Now, a new study in BMJ, while not offering such a link, nonetheless, suggests the possibility exists.
The study examined 5,756 patients between 15 and 49 years old who were prescribed Accutane for severe acne between 1980 and 1990. Ultimately, 128 patients were admitted to a hospital for attempted suicide on 210 occasions and 24 patients committed suicide. After parsing the data and weighing the confounding scenarios, the researchers concluded an increased risk of attempted suicide with Roche’s Accutane or generic versions may exist for up to a year following treatment.
“The data support our hypothesis that severe acne, regardless of exposure to (Accutane), carries an increased risk of attempted suicide…Severe acne is a risk factor for attempted suicide; an additional risk may be present during and up to one year after treatment with (Accutane). Suicidal behavior triggered during treatment more often leads to repeated attempts or suicide than in patients with a history of suicide attempts before treatment” (here is the study).
At the same time, they noted it remains difficult determine to know if a continued rise in suicide risk was “due to the natural course of severe acne, or to negative effects of the treatment.” They wrote that “a more probable interpretation is that the underlying severe acne may best explain the raised risk,” although they could not rule out that it may be “as a consequence of exposure to the drug.”
For instance, some patients may have determined the drug did not provide the expected benefit or, perhaps, their quality of life did not improve even after treatment. The researchers also acknowledged that two to three years after treatment, the observed number of suicide attempts was close to the expected number, given the background rate in the population.
The issue has generated controversy for more than a decade. In particular, one family from Ireland has, for years, attempted to prove a scientific link and its legal efforts recently forced the European Medicines Agency to disclose adverse event reports (back stories here and here).
MIKE MYERS
While your article states the facts of the study accurately, the title you used is sensationalistic and misstates the key study takeaways.
Ed Silverman
Hi Mike,
Thanks for the note, but the headline is not designed to be sensational and reflects the conclusion as the authors stated: “an additional risk may be present during and up to one year after treatment.”
I agree that there are caveats and limitations, which means there are a great many subtleties to chew on. But I tried to convey the bottom-line conclusion as it appears in BMJ.
Interestingly, here is a smattering of headlines from other media that attempted to present the same findings:
Acne drug not found to increase suicide risk - BBC News
Study: Major acne problem may raise suicide risk - CBS News
Study on acne suicide risk fuels debate over drugs - Forexyard
Acne linked to suicide risk - The Guardian
No suicide risk link to acne drug - The Scotsman
Acne can double suicide risk - The Telegraph
Acne drug suicide link ‘unlikely’ - Yahoo!News
I’m not sure what to make of the very contradictory conclusions these other headlines offer, except that some folks obviously found the results confusing. But again, I tried to hew to the messages contained in the discussion and conclusion sections.
I hope this helps,
Ed
bmartinmd
A more accurate headline would have conveyed the authors’ belief that severe acne, rather than Accutane, was associated with an increased risk of suicide.
From the article: “We must stress that we cannot exclude the possibility that the raised risk of suicide attempts during treatment and six months after treatment is due to the exposure to isotretinoin. However, a more probable interpretation is that the underlying severe acne may best explain the raised risk.”
Ed Silverman
Hi Barbara,
Thanks for the note. And I understand your point. I had, in fact, cited the same phrase as you: “…a more probable explanation is that the underlying severe acne may best explain the raised risk.” However, as I attempted to explain in my last comment, I noted what the authors themselves concluded:
“What this study adds:
Severe acne is a risk factor for attempted suicide; an additional risk may be present during and up to one year after treatment with isotretinoin
Suicidal behaviour triggered during isotretinoin treatment more often leads to repeated attempts or suicide than in patients with a history of suicide attempts before treatment
A history of attempted suicide may not need to be a contraindication when considering treatment with isotretinoin.”
Again, as I read it, the med may create an additional risk, beyond the separate risk created by severe acne, which I did acknowledge as a key part of the authors’ discussion.
Best,
ed