The Truth About Scary Accutane Side Effects

Here’s some unsettling news: A 15-year-old boy charged in the murder of a 20-year-old woman allegedly plans to blame his acne treatment for his actions.

It seems that the teen was taking the oral acne medication isotretinoin—commonly referred to by the brand name Accutane, which actually isn’t manufactured in the U.S. anymore. (It's still available under different brand names, but for whatever reason, Accutane has stuck.) His lawyers reportedly plan to call on a psychiatrist who studies the mental effects of this powerful drug, according to the New York Post.

If the teen actually does point the finger at his acne medication in his trial, he wouldn’t be the first to do so. Accutane was implicated (then later rejected) as the cause of a 2009 murder, and it has been blamed for several suicides too.

“Isotretinoin does carry with it some potentially severe side effects, but when properly monitored under the guidance of a dermatologist, it’s safe,” says Joshua Zeichner, MD, a dermatologist and director of cosmetic and clinical research at Mount Sinai Hospital’s department of dermatology in New York City. “It is the single most effective drug that we have for severe acne.”

“Accutane is the proverbial silver bullet for acne,” agrees Ava Shamban, MD, a dermatologist in Beverly Hills and founder of SKINxFIVE. “When all else fails, Accutane works 99.9% of the time to cure this disfiguring disease.”

What are the side effects of Accutane?

Isotretinoin is a prescription form of a derivative of vitamin A. It addresses all of the main causes of blemishes, Dr. Zeichner explains. “It decreases oil production, it helps reduce levels of acne-causing bacteria on the skin by starving the bacteria that feed on the oil, it prevents skin cells from sticking together in the follicle, and it reduces inflammation,” he says.

The most common side effects of isotretinoin are not the type of attention-grabbing symptoms making headlines. People taking it frequently experience dry skin, headaches, blurry vision, and muscle or joint pain, Dr. Zeichner explains. The drug can affect the liver too, so users are told to keep their alcohol intake to a minimum, he adds.

Quite a bit more troublesome is that isotretinoin is linked to birth defects. If you’re able to get pregnant, you’ll be required to take regular pregnancy tests during your treatment, which usually takes about four to five months, according to the American Academy of Dermatology (AAD). You’ll also need to use two forms of birth control during the time you take the medication: one hormonal method, and one barrier method, like a condom, says Dr. Zeichner.

Okay, but what about... murder?

Other scary-sounding potential side effects are much rarer, and the connection to the acne treatment isn’t clear. Using isotretinoin has been associated with inflammatory bowel disease (IBD). And it's also been linked to both depression and anxiety symptoms. Yet no research shows that the med directly causes these conditions, let alone trigger someone to kill.

“Stating that Accutane is a causative factor in premeditated murder is absurd,” Dr. Shamban says. “It has been reported that some patients may experience mild depression but never murderous impulses.”

Patients with a history of IBD—especially ulcerative colitis—are often advised not to take isotretinoin, Dr. Shamban says, and teenagers being treated for depression need to get cleared by their psychiatrists before a dermatologist can prescribe the med. Still, people with a history of depression and of IBD have successfully used the acne treatment, Dr. Zeichner says.

It’s worth noting that acne itself can be depressing, Dr. Shamban adds. A large analysis of isotretinoin research published in 2017 in the Journal of the American Academy of Dermatology found that the med was not only not linked to depression, the researchers concluded that having your acne clear up is actually more likely to make you feel better about things.

“However, given the prevalence of depression, anxiety, and suicidal ideation/suicide in the general population, and especially the adolescent population who may be candidates for isotretinoin therapy,” state AAD guidelines for the use of the acne medication, “the prescribing physician should continue to monitor for these symptoms and make therapeutic decisions within the context of each individual patient.”

If you're thinking of trying isotretinoin

That monitoring starts from the day you decide you want to try isotretinoin. You'll have to take a pledge vowing to avoid becoming pregnant (really!) and sign forms acknowledging that you know the risks of taking the med. Then you'll have to check in regularly for follow-up appointments. “There are potentially serious side effects; that’s why we monitor patients monthly,” Dr. Zeichner says, “but it is a life-changing medication and I actively prescribe it.”

If you’re not willing to use two forms of birth control, isotretinoin is probably off the table for you, he says. Otherwise, deciding whether or not to use this powerful acne medication comes down to an individual decision made with your doctor. “In general,” Dr. Shamban says, “the benefit is so much greater than the risks.”