Acne drug may boost suicide risk by lowering serum vitamin D
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Editor's note: In a nutshell, the following report provides evidence suggesting that isotretinoin used to treat acne may decrease serum levels of calcitriol - the active form of vitamin D - and lowering of serum vitamin D boosts the risk of depression and suicide.
It has been observed that taking Accutane or isotretinoin, made by Hoffmann-La Roche Inc and indicated to treat severe acne, has been positively associated with suicides or suicidal attempts.
Accutane has been used by more than 13 million people to treat severe acne since its introduction in the early 1980s, according to Webmd.com.
Last June, the company said it was withdrawing the drug from the market, citing increased competition from its generic counterpart.
A new study published in the journal BMJ Online First suggested that acne itself may boost the risk of depression and suicide and accutane may actually reduce the likelihood that a person who had previously tried to kill himself once would actually try it again.
For the study, researcher Anders Sundstrom, MD and colleagues followed 5,700 patients with severe acne and found the risk of suicide in the patients with severe acne was increased, even several years before treatment; that risk elevated for several months after treatment.
However, the highest risk was found during the six months after treatment ended. For this, the researchers explained, the patients may feel desperate when after observing that the treatment did not improve their skin condition as much as desired.
Sundstrom was cited as saying doctors need to recognize that patients with severe acne may be at higher risk for depression and suicidal behaviors.
The researchers suggested that patients need to be monitored during treatment with accutane and for one year after the treatment ends.
No one knows why acne was linked to higher risk of depression and suicidal thoughts or attempts or whether acne or acne drug boosts the risk.
A health observer told foodconsumer.org that the missing link between severe acne and elevated risk of depression and suicidal thoughts could be vitamin D deficiency.
First, vitamin d deficiency, which is more likely to occur in residents of states like Oregon and Washington, possibly because of the grey weather, has been associated with elevated risk of depression and suicide, according in part to VitaminDcouncil.org.
On the other hand, treatment of acne with accutane or isotretinoin can significantly reduce serum levels of 1, 25-dihydroxyvitamin D or Calcitriol or the active form of vitamin D, according to a study in a 1992 issue of Acta dermato-venereologica.
Rødland O and colleagues of the University of Bergen in Norway tested serum levels of vitamin D metabolites in 11 patients treated for cystic acne with a four-month course of isotretinoin or Roaccutane. The levels were measured before and after two months of treatment.
The researchers found serum levels of 1,25-dihydroxyvitamin D dropped significantly in acne patients treated with isotrenitoin.
This evidence explains perfectly why acne patients are at their highest risk of suicide six months after treatment with Accutane.
Dr. John Cannell, a vitamin D expert and director of Vitamin D Council said in the organization's newsletter dated Oct 2008 that a reader reported her teenage son with type 2 diabetes had taken 5000 IU of vitamin D a day for about 6 months and then he started losing weight, improving blood sugar and eventually eliminating his acne.
According to Dr. Cannell, a paper published in 1938 already mentioned the therapeutic effect of vitamin D against severe acne. The dose used ranged from 5,000 to 14,000 IU per day.
David Liu and Rachel Stockton
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