Bella Thorne has publicly spoken out about dealing with depression, which she says was sparked largely by a barrage of hurtful messages on social media.
But in a brightly lit studio, Thorne described another way her darkest thoughts were unleashed. Her theory — though not clinically diagnosed — is that a controversial acne medication known for its potentially harmful side effects, including suicidal thoughts, sparked her depressive symptoms.
“Accutane made me depressed,” Thorne shares with me. Of course, 19-year-old Thorne wasn’t actually talking about Accutane, a drug that the Food and Drug Administration withdrew from the market years ago. Instead, Thorne was referring to the drug’s current, generic form called isotretinoin, which is available today by a prescription.
Regardless of its name, I knew exactly what she was talking about. I myself have taken isotretinoin to combat cystic, nodular acne. For the blessedly uninitiated, nodular acne isn’t just a blackhead; it’s many red, swollen, tender lumps that form beneath the skin’s surface.
From age 15 to, well, today, I’ve tried topical acne treatments, cosmetic procedures, and prescription oral medications. There were the salicylic washes, toners, and moisturizer combos; the Clarisonic cleansing brushes; the antibiotics like doxycycline and clindamycin; the birth control pills; the broadband light and profractional laser treatments; the chemical peels; and of course, isotretinoin.
Because of the process to get an isotretinoin prescription, as well as the drug’s potential side effects, using the medication can be equal parts physically and emotionally exhausting. It’s often prescribed as a last resort for patients who have tried to control their acne unsuccessfully for years, like I had.
The FDA closely regulates the distribution and use of isotretinoin in the U.S. While an ordinary prescription might require you to see a doctor once before being given a six month supply, an isotretinoin prescription requires patients to legally sign on to the iPLEDGE program, which is exhaustive, to say the least.
As part of the program, patients agree to monthly appointments with your prescribing physician, monthly blood tests, and pregnancy tests since the medication is linked to birth defects if taken while pregnant. If you’re a female patient, you must call in to the iPLEDGE telephone service with each renewed 30-day supply to confirm that you are not pregnant and are still taking two forms of approved birth control before your doctor can even send the prescription to the pharmacy. From the iPLEDGE site:
“[Female patients] must have 2 negative urine or blood (serum) pregnancy tests with a sensitivity of at least 25 mIU/ml before receiving the initial isotretinoin prescription. The first pregnancy test is a screening test and can be conducted in the prescriber’s office. The second pregnancy test must be done in a CLIA-certified laboratory according to the package insert.”
“The iPLEDGE system verifies that all criteria have been met by the prescriber, patient, and pharmacy prior to granting the pharmacy authorization to fill and dispense isotretinoin. The pharmacist must obtain authorization from the iPLEDGE system via the program web site or phone system prior to dispensing each isotretinoin prescription for both male and female patients.”
Worth noting: Birth defects and mental health risks are the more extreme side effects, though many patients suffer from any one of the following during treatment: sensitive skin, chapped lips and skin, bloody noses, and vision changes.
However, the majority of people who take isotretinoin find their acne has been “cured,” though there isn’t really a cure for acne at all. Of those who take isotretinoin for a six-month period, there is a 70 percent “cure rate.” That leaves 30 percent of people who may have to undergo treatment a second time without a guaranteed cure.
So for all of this, why bother with a drug that was in one breath called “one of the most dangerous products on the market” and in another, “one of the most effective prescription drugs available?”
In short, it’s controversial, according to New York City dermatologist Sejal Shah. Shah tells Yahoo Style that in larger data sets, the cause and effect relationship between isotretinoin and depression hasn’t been proven and some seemingly damning reports about the drug may be “blown out of proportion.”
“There are some people who develop mood changes on isotretinoin, but it’s not a clinical depression,” Shah says. “It’s hard, with tracking your mood, especially since there are so many things that can affect your mood and how you’re feeling.”
It’s true, the headlines can be alarming. A Daily Mail article from 2015 reported that 20 people committed suicide over a two-year period while on Roaccutane, an isotretinoin treatment, a figure reported by Britain’s Medicines and Healthcare Products Regulatory Agency. Still, the government agency’s review of the Roaccutane drug “concluded that there was ‘insufficient data to establish a causal association’ with psychiatric disorders.”
So when I spoke to Thorne, I remembered the painful, shameful trips to makeup counters with my mom, searching hopelessly through teary eyes for a cosmetic reprieve from my inescapable teenage acne. And my own wild mood swings and depressive thoughts.
But for all of my own issues with isotretinoin — and my ongoing struggle with acne — I can count my blessings. I don’t have to worry about swarms of paparazzi waiting at my door to photograph me, with or without the armor of makeup.
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