I took Accutane at the same time I was treated for depression, I didn’t notice any change. This was the 90s, I don’t know what clinical trials said then but it wasn’t publicly known that there were any links. What was striking were the birth defect warnings, pictures of deformed babies all over the blister pack (it didn’t come in bottles, at least not then).
The Bimzelx doc I posted above noted they were comparing the drug to placebo, and also within-subjects change in both populations.
Welcome, Appladay!
Yeah, once after my wife had surgery the nurse explained that she was administering scoplolamine to prevent nausea. I thought, “Wow, isn’t that one of the alkaloids in jimson weed?” Yep, one in the same. Of course, the main problem with people consuming jimson weed is the large variation in the concentration of the alkaloids from plant to plant. Scopolamine is generally pretty safe as a refined prescription drug, but due to it crossing the blood-brain barrier one of the side effects can be hallucinations. Biochemistry is weird.
In a former life, I used to do some work related to medicine and litigation.
Generally, there are warnings (yawn) and then there are absolute contraindications. Accutane causing birth defects during pregnancy is an absolute contraindiction (ie, it will happen). That level of certainty in risk is rare. To break through the noise, you’ll know and it will look different. So pictures of deformed babies.
Other warnings, which are most side effects, are less certain. It’s more, studies show it can increase the risk of the side effect. That could translate to, 2% chance in normal life; 4% chance on the medication (ie, it doubles your risk…but so what). Not likely overall, but it does increase the risk and you are being warned about that. Take it or don’t, up to you and your doctor.
My anecdotal opinion, having deposed many doctors, they don’t understand much of this and how to mathematically evaluate risk/benefit. They know through experience, but not the math part…they don’t know it’s only 2% to 4%, or the benefit isn’t actually that beneficial.
Like, a med will say it will increase bone density 50% more than Vitamin D alone. Or something like that. The reality is vitamin D (or doing nothing) is 95% effective for proper bone density and taking the med just makes it 97.5% effective for proper bone density. It’s just a 50% increase in that relative 5% amount. I would say, mathematically, you’re taking a lot of real risk for almost no gain in benefit. There are a lot of medicines with these kind of claims and effectiveness. It’s been a minute, hopefully I didn’t butcher the math, as the phrasing is subtle yet specific for the math to work in a very misleading but technically true way.
Doctors were always surprised by this kind of stuff (eg, Doctor: I thought a 50% increase was a lot!). To the point they would consider changing their recommendation.
Late: fyi, really, Accutane started out as an anti-cancer drug. Wasn’t that effective for cancer, but their faces sure looked good when they were on it…start prescribing it for acne.
I’m a retired pharmacist. Accutane (isotretinoin) causes terrible birth defects if taken during early pregnancy, and also does really wonky things to cholesterol levels, especially triglycerides. The latter thankfully goes away when the drug is discontinued. The depression and suicide risks are indeed higher than background, which is also why it’s part of the warning.
As I recall from the news in the last decade or so, some new drugs do increase the risk of suicidal thoughts. It’s not usually indicated how this mechanism works, but I presume one process is that some drugs may lower the inhibitions in people who already have a tendency to depressive sucidal thoughts. What I also recall is that the concern was it was more prevelant in younger patients - perhaps the ones more prone to depression.
The brain works in odd ways. Getting drunk is such a common thing that we don’t really think about all the ways it affects brain activity, from release of inhibitions to lack or coordination, urge to vomit, hallucinations, loss of memory, drunk dialling, euphoria or depression, death, etc. That’s from a simple alcohol - whereas a different form of alcohol can be even more toxic. We should not be surprised if some drugs have similar effects.
There are unknowns when a drug is given via the skin. Drugs diffuse at different rates dependent upon the quantity of lipid (fat) in the skin, they begin and end differently dependent upon the thickness of the skin, they distribute more quickly dependent upon the local capillary blood supply, and they distribute dependent upon the local arterial pressure. And all that unknown is before we get to the brain that it’s going in. So… you’re so very right about the differences between one person’s reaction to a drug, and another. Add in the age, underlying mental reserve capacity, and competing drug reactions, and we should all be careful with all drugs. Even those given via the skin. Cheers.
MS involves the autoimmune system in all cases. That’s what it’s all about. It’s kinda the poster child of autoimmune diseases, IMO.