MEDICINE AND MENTAL HEALTH : The Isotretinoin Issue
MEDICINE AND MENTAL HEALTH : The Isotretinoin Issue
The possibility of introducing prescribing options for New Zealand psychologists is currently being considered. Clinicians have been invited to offer opinions on the advisability of such a move and to make suggestions on additional training requirements. Certainly, an extensive understanding of the possible side effects of such medications likely to be prescribed would be required.
In fact, an understanding of the possible short- and long-term side effects of medications in general is already an area that warrants considerably more attention from all those working in mental health. The possible, very serious mental health consequences of ingesting certain prescription medicines are currently outlined in a number of medication inserts. In addition, agencies such as the US Food and Drug Administration (FDA) have published warnings cautioning against the use of some prescription medicines, which they state may cause serious psychiatric disturbance. There are also currently proposals in Britain to give every new drug licensed a ‘suicide rating’.
This reform, based on a system adopted recently in the United States, has been fuelled by a growing body of evidence that drugs that affect the brain can heavily influence behaviour through seemingly innocuous changes in body chemistry. Medicines to treat acne, swelling, heartburn, pain, obesity, high blood pressure and cholesterol, bacterial infections, smoking and insomnia have all been associated recently with psychiatric problems. (Mostrous, 2008).
One such medication is isotretinoin (also known as Accutane or Roaccutane), prescribed for the treatment of acne. This vitamin A derivative, manufactured by Hoffman-La Roche, is one of that company’s most popular and controversial medications. In its most recent warnings the FDA (FDA, 2005), stated:
FDA ALERT [7/2005]: Suicidal Thoughts or Actions: In addition to the strengthened risk management program, FDA continues to assess reports of suicide or suicide attempts associated with the use of isotretinoin. All patients treated with isotretinoinshould be observed closely for symptoms of depression or suicidal thoughts, such as sad mood, irritability, acting on dangerous impulses, anger, loss of pleasure or interest in social or sports activities, sleeping too much or too little, changes in weight or appetite, school or work performance going down, or trouble concentrating, or for mood disturbance, psychosis, or aggression. Patients should stop isotretinoin and they or their caregiver should contact their healthcare professional right away if the patient has any of the previously mentioned symptoms. Discontinuation of treatment may be insufficient and further evaluation may be necessary.
The ‘Patient Information Sheet’ for this medication also reads:
Serious mental health problems: Isotretinoin may cause:
- Depression
- Psychosis (seeing or hearing things that are not real)
- Suicidal thoughts or actions
-Aggressive and violent behavior