Bitter Medicine? (Family Wonders if Accutane Caused Son's Depression)

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Bitter Medicine?

(Family Wonders if Accutane Caused Son's Depression)

by Rene S. Ebersole

By Rene S. Ebersole Jan 5, 2001 Current Science Magazine

A U.S. congressman has implicated a popular acne medication in the suicide of his teenage son.

On the morning after his junior prom last spring, B.J. Stupak, 17, raised a .38 caliber revolver to his head and pulled the trigger. Just hours before, B.J. had smiled for photographs with his friends and thanked his parents for coming to see him on the prom court.

"We told him he looked great and we were proud of him," said Laurie Stupak, B.J.'s mom. She and B.J.'s dad, U.S. Congressman Bart Stupak of Michigan, had agreed to let their older son chaperone a party for B.J. at their house. At the party, B.J.'s typically cheery mood turned gloomy. Around 3 a.m., he read aloud from the Bible and told his friends that he wasn't going to college because his grades were too low. He said his parents probably hated him for that. Then, around 7 a.m., a shot rang out from the downstairs family room.

"B.J. was always an upbeat, positive kid," said Congressman Stupak, who also said that B.J.'s behavior that night was "completely out of character." The Stupaks don't believe B.J.'s 2.43 grade point average drove him to such a desperate act. In October, they appeared on national television and blamed a popular acne medication for their son's suicide. "We've considered every possible explanation," they said on NBC's Today Show. "The only thing we can find is Accutane."

Like millions of teens, B.J. suffered from acne, a condition that occurs in the sebaceous glands (oil glands) on the face, scalp, neck, shoulders, upper arms, chest, and back. The sebaceous glands are named for sebum, the oily substance they secrete. Sebum keeps skin soft and flexible.

Sebum production escalates whenever there is a change in the body's hormones, such as during puberty, a period of rapid growth and development that usually occurs between the ages of 11 and 14. People vary in the way their skin responds to hormonal changes. In some, the sebaceous glands become clogged with excess sebum. When that happens, the sebum seeps into the surrounding tissues, which then become inflamed (red and swollen). Pimples form. Clogged glands are prone to bacteria buildup, which only makes pimples more persistent.

Many people who have persistent acne seek the help of a dermatologist, a doctor who specializes in skin problems. Stephen Webster, a dermatologist at the Gundersen Lutheran Medical Center in La Crosse, Wis., says more than 90 percent of patients with acne can be treated by topical medications such as benzyl peroxide, which help dry out clogged oil glands, or by antibiotics, such as tetracycline, which kill bacteria.

Accutane, or generic isotretinoin, is an oral medication prescribed for only the most severe acne, called papulo-cystic or nodular acne and identified by deep walnut-shaped lesions. Accutane reduces oil production by shrinking the oil glands.
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SUICIDE TRAIL Shortly after her son's suicide, Laurie Stupak came across B.J.'s Accutane pills. "Call it mother's intuition, but I couldn't get Accutane out of my mind that day," she said. When she typed "Accutane" into an Internet search engine, she couldn't believe what she found.

In 1998, after a number of reports of suicide were filed with the U.S. Food and Drug Administration (FDA), the agency required Hoffmann-La Roche, the maker of Accutane, to notify doctors about the possible psychiatric side effects of the drug. The FDA also instructed Hoffmann-La Roche to print a warning on a package insert distributed to physicians and pharmacists that said: "WARNING: Accutane may cause depression, psychosis, and rarely, suicidal ideation [thoughts about suicide], suicide attempts, and suicide."

Later, the FDA recommended that Hoffmann-La Roche add the warning to the label that accompanies the packages of Accutane pills that go to patients. The company changed the package label on May 1, 2000, 14 days before B.J. Stupak committed suicide. The Stupaks are enraged that B.J.'s pills did not carry the warning--and they're not alone. Many parents around the world have blamed Accutane for their children's suicide or depression, an emotional state marked by sadness, inactivity, and a reduced ability to enjoy life.
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CHANGING TIDE

In September, weeks before the Stupaks went public, the FDA met with a panel of experts to discuss Accutane and a possible link between it and suicide and depression. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research, said there is not enough data at this time to establish a causal link. "However, there is enough cause for concern that steps should be taken to nail this down," she said.

The FDA has asked Hoffmann-La Roche to develop a medication guide for patients that gives information about the risks associated with Accutane. The agency also advised the company to launch further studies on the psychiatric complications associated with Accutane.

Congressman Stupak says Hoffmann-La Roche's plan to implement a medication guide is "a step in the right direction. We're losing young people. We need independent studies. We're going to have to keep on [Hoffmann-La Roche and the FDA]. And that we will."

COPYRIGHT 2001 Weekly Reader Corp.
COPYRIGHT 2001 Gale Group

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