Acne drug spreads despite depression, suicide link

- Daily News Egypt

07/28/2008- CAIRO : For teenagers around the world, acne is a constant source of depression and lack of confidence. Egyptian youth are no different, as they continue to seek both mainstream and alternative medicines to get rid of the coming-of-age disease.

The effectiveness of mainstream medication and remedies often varies from one person to the next, but no drug enjoyed as much success as Roche’s Roaccutane. But its magic effect does not come without a price tag.

Twenty-year-old Nada (not her real name) still suffers frequent panic attacks as she remembers her story with the drug, popularly referred to as “the miracle drug.”

Suffering from mild summer-time acne, Nada reached out to Dr Mona El-Okabi, a well-known dermatologist with a good reputation for curing acne for many patients.

The drug worked like “magic” on her face before leaving her depressed and experiencing severe mood swings, erratic aggressive behavior and hysterical fits.

Roaccutane was approved for adults in 1982 by the FDA to treat only a very special type of nodular acne that did not respond to any other type of therapy, but only few practitioners in Egypt follow these instructions.

A study published in the American Journal of Psychiatry, “Functional Brain Imaging and Alterations in Acne Patients Treated with Istrotenion” (Roaccutane’s effective ingredient), suggest that the chemical is largely associated with changes in brain functions.

The study showed decreased brain functioning in the orbito-frontal cortex, the part of the brain linked to feelings of depression, after a treatment period of four months. It also showed a variety of negative effects on neurological chemical systems, such as the neurotransmitter of the brain, dopamine.

The Canadian Adverse Drug Reaction Monitoring Program also reported that Roaccutane caused depression and prompted suicidal thoughts at 25 percent of patients they monitored from 1983 to 1999.

The Roaccutane Action group, founded by a man whose son committed suicide while on the drug, argued during a presentation to the FDA in 2000 that when compared to five other drugs, Roaccutane appeared to be 900 times more likely to cause depression.

Nevertheless, Dr El-Okabi insisted all this was irrelevant.

“This medicine, on the contrary, makes girls happy; they are depressed from the acne they have on their faces,” Dr El-Okabi told Daily News Egypt.

“Once I prescribe the drug and they begin seeing the results, they are much more confident … all they want to do is go hang out and have a boyfriend,” she added.

Dr Abdel-Nasser Omar, a psychiatrist, didn’t point fingers at the drug but insisted doctors should be aware of the patient’s medical history before prescribing it.

“This medicine should not be taken unless the doctor is sure that the patient does not have a history of depression, nor does his family,” Dr Omar told Daily News Egypt.

Interviewing 10 people, all former users of the drug, revealed that none of them were informed of the possible side effects.

“It is a simple, small equation. Time is money, taking time to tell every single patient about the possible side effects means taking 10 more minutes with a patient. The doctor wants to make the best of his time, which means having as many patients as possible,” Dr Adel Sultan, a dermatologist explained.

Meanwhile, Roche — one of the world’s leading drug manufacturers which produces the drug — insisted they were not to blame.

“It is not our responsibility that doctors don’t tell patients about these issues, our role ends when we write the possible side effects on the pamphlet,” a Roche spokesperson told Daily News Egypt on condition of anonymity because he was not authorized to speak to the media.

Roaccutane, which costs LE 500 monthly for six months while on the 40 mg treatment, should be administered in the small dosage of 0.5mg/kg/day. For a 50 kg person, 25mg would be the ideal dosage, according to Roche.

”I was prescribed 90 mg, even though I weighed 120 kg,” says Mohamed Salem, also a patient of Dr El-Okabi.

The “Neurobiology of Retinoic Acid in Affective Disorders” study clearly shows that 25 percent of patients receiving doses of 3mg/kg/day of Istrotenion — three to six times higher than the dose used for acne —  developed symptoms of depression. This is much higher than the 3–4 percent reported in most other studies.

Meanwhile, Nada looks amazed when told all her aggressive behavior and mood swings resulted from her usage of the drug.

“Yes, I used to get all of these sudden mood swings, I would cry for no reason. I never knew what the reason was, I didn't believe all this was from the drug,” Nada tells Daily News Egypt.

Speaking on condition of anonymity, one dermatologist refused to comment on the widespread perception that doctors receive favors in return for prescribing certain expensive drugs, including Roaccutane.

The Roche spokesperson however, said the assumption was out of the question.
 
“We even stopped promoting that medicine,” he told Daily News Egypt.

Roaccutane can be purchased from any pharmacy without prescription.

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