Should I go on Roaccutane? My thoughts on Isotretinoin for Acne.

Mehgan Weatherley
Jul 5, 2021
7 min read

'Should I go on Accutane, Meg?'

'What are your thoughts on Accutane?'

These are two of the most frequently asked questions you ask me over on Instagram.

And here's the short answer: I can't decide that for you, and I don't have a black or white answer to give you.

This article is the long answer to the question 'Should I go on Accutane?'

First and foremost, what medication you go on is between you and your doctor. It's not for me or anyone else to push you to go on it or to stop you from going on it. Taking medication is a very personal decision and there's so much nuance for each individual.

I'm no stranger to taking conventional medication, I was on the birth control pill for over ten years and I've been on anti depressants. I understand the need for medication. Having said that, I never went on Isotretinoin (Accutane) and so I don't have personal experience with the drug, other than my mother telling me about her experience (she went on it many years ago).

I believe in making informed choices about what we put into our body, it's important to weigh up the pros and cons of any medications you want to take.

Let's dive headfirst into Isotretinoin and how it works.

Isotretinoin (brand name is Roaccutane or Rizuderm in the U.K.) is a drug taken orally via capsules (1), it's known to be very effective at clearing acne quite quickly. It is mainly used for severe acne, and when other milder drugs or topicals have failed. It's a retinoid and a derivative of vitamin A.

Isotretinoin is used for acne, but also for some forms of skin, head and neck cancer (2).

'It acts primarily by reducing sebaceous gland size and sebum production, and as a result alters skin surface lipid composition.' (3)

As the drug inhibits sebum production, it's excellent at stopping acne in its tracks. But it's not without side effects. It's stated to only be used as a last resort:

'Because of significant adverse effects associated with its use, isotretinoin capsules should be reserved for patients with severe nodular acne who are unresponsive to conventional therapy, including systemic antibiotics.' (4)

Before I list the most common side effects, I think it's worth pointing out here that for some people, this medication could be life changing and potentially life saving. If a person with severe acne is experiencing intense depression because of their skin or is avoiding social interaction, then going on Isotretinoin may be the best decision they make for their mental wellbeing. In this case, the pros of the medication outweigh the cons. Their quality of life may drastically improve once their skin has cleared up. (There are multiple factors as to why someone isn't able to heal their acne holistically, here's an article I wrote on this subject.) And so, going on this medication may be the best decision for this person.

Now to the list of the most common side effects (taken from the NHS website):

'skin becoming more sensitive to sunlight
dry eyes
dry throat
dry nose and nosebleeds
headaches and general aches and pains'

These are more serious side effects also taken from the NHS website (happen in less than 1 in 1,000 people):

'anxiety, aggression and violence, changes in mood, or suicidal thoughts - these can be signs of depression or other mental health problems
severe pain in your stomach with or without diarrhoea, feeling or being sick (nausea or vomiting) - these can be signs of a serious problem called pancreatitis
bloody diarrhoea – this may be a sign of gastrointestinal bleeding
a serious skin rash that peels or has blisters - the skin rash may come with eye infections, ulcers, a fever, and headaches
difficulty moving your arms or legs, and painful, swollen or bruised areas of the body, or dark pee - these can be signs of muscle weakness
yellow skin or the whites of your eyes turn yellow, difficulty peeing, or feeling very tired - these are signs of liver or kidney problems
a bad headache that doesn't go away and makes you feel sick or be sick
sudden changes in eyesight, including not seeing as well at night'

What the drug does to the body (called pharmacodynamics) is poorly understood. One thing is for sure, you do not want to get pregnant on Isotretinoin. Do not use if you're trying to conceive or if you're already pregnant/may become pregnant.

Isotretinoin is classified as a teratogen, which is 'An agent that causes the production of physical defects in the developing embryo.' (7) Therefore, to go on Isotretinoin it's recommended you use two methods of contraception or abstain from intercourse.

The medication can also affect the liver, which is why when taking Isotretinoin your liver function will (or should) be monitored. Here's an interesting trial that looked at the effect of Silymarin (milk thistle) for those taking Isotretinoin, it may be worth considering taking a high quality milk thistle tincture if your liver needs support from taking Isotretinoin - always consult with your healthcare professional when bringing in any herbs or supplements.

Here's the patient leaflet that comes with Roaccutane, if you want more information on side effects and so on.

The Potential link between Isotretinoin and Digestive Problems

There have been a number of reports around stomach area issues (Irritable Bowel Syndrome, Ulcerative Colitis, Crohn's Disease, and so on), in fact a number of lawsuits have been filed around this issue.

A 2010 study on Isotretinoin and Ulcerative Colitis concluded that 'Ulcerative colitis but not Crohn’s disease is associated with prior isotretinoin exposure. Higher dose of isotretinoin appears to augment this risk. Though the absolute risk of developing UC after taking isotretinoin is likely quite small, clinicians prescribing isotretinoin as well as prospective patients should be aware of this possible association.'

To contradict this, a 2016 meta analysis concluded that 'Isotretinoin exposure is not associated with an increased risk of developing both ulcerative colitis and Crohn's disease.'

It appears the jury is still out, but I'm sure those people that have taken Isotretinoin and since dealt with digestive issues would disagree.

The History of Isotretinoin

Accutane was developed in the early 1980s, with the US Food and Drug Administration (FDA) giving the drug a category X pregnancy rating (a warning to not take the medication if you're wanting to get pregnant or are already pregnant) and a black box warning.

In 1998, the FDA issued a warning to physicians regarding a possible association with depression, psychosis, suicidal ideation, and suicide. For a more detailed history of the drug, read this article.

'On June 29, 2009, Roche Pharmaceuticals, the original creator and distributor of isotretinoin, officially discontinued both the manufacture and distribution of their Accutane brand in the United States due to what the company described as business reasons related to low market share (below 5%), coupled with the high cost of defending personal injury lawsuits brought by some people who took the drug.' (14)

Isotretinoin is being marketed under many different brand names worldwide, in the U.K being Roaccutane or Rizuderm.

Does Isotretinoin cause Depression or does it help with it?

Much of the controversy around Isotretinoin is about the negative mental impact it can have on some people. The Medicines and Healthcare products Regulatory Agency are currently reviewing the safety of Isotretinoin and have noted they're particularly interested in the psychiatric and sexual side effects from the medication.

In 2019, 12 deaths were recorded: 10 by suicide, by people who had been prescribed Roaccutane according to data from the Medicines and Healthcare Products Regulatory Agency (MHRA).

Despite all this, studies have not found a direct link. In a study on the risk of suicide attempt associated with Isotretinoin they concluded: 'Compared with the general population, a lower risk of suicide attempt was observed among patients exposed to isotretinoin and there was no evidence for a triggering effect of isotretinoin initiation on suicide attempt.' (1 7)

In my opinion, I believe the drug could both cause depression in some people and also, alleviate depression in those that find relief from their skin clearing up.

I feel deeply for the parents of the children who have taken their own lives after taking Isotretinoin.

I also know that for some people, taking Isotretinoin was a life saver.

Knowing both sides of the coin makes it a difficult decision to make, of whether to go on the drug or not.

My Mothers Experience with Roaccutane

My mum went on Roaccutane a long time ago (over 30 years ago) but she still remembers the side effects of the medication. I asked her if she could share her experience briefly and she said that it worked in clearing her skin, but then her acne did return further down the line, she was offered a second round of Roaccutane and refused. The main side effects my mum remembers is very dry lips, hair loss (bald patches) that her hairdresser noticed and mood issues. The medication made her feel quite low in mood, and this was the main reason she didn't want to go back on it.

What my mum experienced definitely influenced my decision to not go on the drug, the idea of it making me feel even lower in mood was a big no-no for me, along with the long term impacts it could have had on my body.

In my opinion

Honestly, the more time I've spent researching Isotretinoin, the more alarmed I become at the potential side effects. I wanted to make this article as neutral as possible, but I'm human (therefore biased, which we all are). I worry that people's side effects are not being taken as seriously as they should be. I'll be honest and say as much as I try to be unbiased, I don't have good feelings towards it - I personally wouldn't want my child going on it.

To conclude...

With any medication, there are potential side effects. Does this mean that you'll experience all of them? No. But there's a possibility. So, should you go on Isotretinoin? I put the question back into your hands, there's no way I'd want to decide this for anyone. Speak to your doctor and weigh up the pros and cons, whilst also listening to your gut instincts.

I highly recommend reading through some of the links below. References/further reading:

By Mehgan Weatherley

**My work is copyright protected, including this article, please do not copy, redistribute, take any part of my written work and call it your own. If you would like to take excerpts from this article, you will need to give full credit and link to the original article.**