The Neuro-Protective Lifestyle

So here’s the deal, medication has its place, but this one belongs on your face - NOT in your body!

photo credit: Syma Sees

Suicide and the depression that precipitates it, is common in North America. Common enough to be the third leading cause of death for people aged 15 to 24.

Acne unfortunately, especially the nodulocystic form that can lead to scarring, is also very common in that same age group. Accutane® or 13-cis-retinoic acid (RA),is considered the “drug of choice” for cystic acne and is effective in 90% of cases.

In one 13 year time period (1989-2003), 72 of 216 documented teen suicides were unequivocally linked to Accutane®. The next highest number of suicides in that time period — 55 — involved Prozac® (fluoxetine).

Accutane® and all fat soluble derivatives of vitamin A, have a long history of causing serious side-effects. Hypervitaminosis A (vitamin A toxicity), from eating polar bear liver has always been a part of the oral tradition of the Inuit people. In 1597 European explorers of Nova Zemlya, an archipelago in the Arctic Ocean, died after eating both polar bear liver and the livers of their sled animals. Acute vitamin A toxicity can cause headache, nausea, vomiting, blurred vision and hair loss. Desquamation (shedding of skin), liver toxicity and birth defects round out the list of known toxicities.

While today virtually no one is in danger of vitamin A toxicity from eating polar bear liver, Accutane® continues to be Roche Pharmaceutical’s number one selling drug. And while doctors have known for years about the common toxicities, what is not known is the effect 13-cis-retinoic acid has on the adult and adolescent brain.

Accutane’s affinity for the CNS and its history of causing serious birth defects may hold the key.

Areas of the brain that continue to generate new neurons are especially susceptible to the teratogenic effects of Accutane. In one study clinical doses of Accutane (1mg/kg/day) fed to adult mice significantly reduced neurogenesis in the hippocampus. The hippocampus is part of the limbic system in the brain and along with the amygdala helps regulate emotion and behavior.

In another study, 28 acne patients underwent positron emission tomography (PET) and MRI scanning before and after 4 months of treatment with either an antibiotic or Accutane®. Neither group suffered from depression at the beginning of the study. After 4 weeks, PET scans were able to detect a decrease in metabolism in orbitofrontal cortex of the Accutane® group but not the antibiotic group.

The orbitofrontal cortex (OFC), is also considered part of the limbic system and communicates directly with the thalamus and indirectly with the hippocampus. In previous neuroimaging studies of untreated depressed patients, the OFC actually shrinks in volume overtime and reflects the severity of the depression.

This may be a good time to point out that while no study to date has shown definitively that Accutane causes suicide, the association continues to be strengthened rather than weakened with each study performed.

I also want to point out that the FDA website carries a strongly worded warning (see boxed warning below), regarding the psychiatric side-effects of Accutane®

As a final word, Accutane® and now three other medications† have recently been linked to linked to serious psychiatric side-effects. To date, none have been withdrawn from the market.

If you are dealing with mild to moderate acne, Accutane® should not be a treatment consideration - especially if a family history of depression exists. Alternatives exist for moderate acne and combination therapy may be best for severe nodulocystic acne, making 13-cis-retinoic acid a literal last resort.

†Chantix, Singulair, Tamiflu

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