By Beverly Creamer
Advertiser Staff Writer
Months after the 17-year-old son of Michigan Congressman Bart Stupak committed suicide, the family continues to focus national attention on a medication that is used to treat acne, and which the teen was taking at the time.
The Stupaks have raised the question that Accutane — taken by more than 5 million Americans, and 12 million people worldwide — may have been a psychological trigger that led the boy to take his life.
With psychological concerns becoming more prominent in the past year, Hawai‘i dermatologists are continuing to prescribe the medication in severe cases, but are also taking time to talk to their young patients and the patients’ parents about side effects, including the possibility of serious mental disturbance.
"I tell my patients if there’s any change in mood to stop the drug and call me," said Dr. Roman Glamb of Straub Clinic & Hospital.
"I think it’s a rare phenomenon," he said, "but I have had some patients who experienced mood changes (depression) on the drug. One wanted to tolerate them, and another stopped the drug."
Glamb said studies have indicated there is no increased depression in study subjects given Accutane as compared to control groups that didn’t receive the drug.
"But, without a doubt," he added, "there are certain susceptible individuals that definitely get depressed when they’re on that drug and experience mood changes."
Dr. Bruce Mills, a dermatologist with the Honolulu Medical Group, has had a handful of patients who became "emotionally volatile" and angry on the drug. "They came in and discussed it and we talked about stopping it or changing the dose. We didn’t and the anger cleared."
Mills said Accutane is the only option for those who suffer such extreme acne that it could cause psychological as well as physical scarring. In those cases, he said, depression could well be associated with the acne conditions.
"We use it extensively here, on a large number of patients. We are all aware of the new concerns and inform patients this could be a consideration," he said.
Because of such concerns, Dr. Philip Hellreich does a psychological profile of patients when he’s considering Accutane.
Hellreich said the overwhelming majority of his patients do well on the usual acne therapies, and Accutane should be reserved for those who "look awful, feel awful, have tender, painful skin and are in severe emotional and psychological distress."
Along with that he asks for lab work on cholesterol and other lipid levels, and liver function. The drug may affect both, even though the potential liver impact isn’t clear.
For women patients of child-bearing age he asks for a pregnancy test as well as proof of two forms of birth control before he will prescribe it. "Its major effect is birth defects. That’s the factor that limits its use the most."
During treatment, which could last five months, he also asks for monthly checks in each area of concern.
The drug has been in use since 1982, and Glamb said it has helped many people. "It would be a shame if there are restrictions on its use." In Europe, he said, the drug is prescribed in a lower dosage over a longer period of time "and the side effects seem to be less intense."
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