Lawmaker attributes son’s suicide to Accutane 

Oct. 22 — Adolescence is not an easy time, not for the teen-agers living through it, or for anyone living in the same house — hormones, mood swings and those agonizing battles with acne. Parents who thought they’d found a cure for their son’s acne say they didn’t know about the possible side effects until it was too late.

Just last month, the FDA called for a hearing on Accutane. Harvard psychiatrist Dr. Doug Jacobs, who specializes in suicide, was commissioned by Hoffman-LaRoche to do a study on Accutane, depression and suicide. He looked at 64 suicide cases from around the world and did what’s known as a "psychological autopsy." He says he was looking for patterns among the suicides but found none.

"Some will have a family history, some will have ... the person was using alcohol, some will have a prior history of suicide attempts. There were over 30 suicides that committed suicide off of Accutane, anywhere from six months to 10 years," Jacobs said.

Arnot: "Can Accutane be blamed, even in small part, for even a single one of these suicides?"

Dr. Jacobs: "I can say unequivocally that Accutane cannot be blamed for any one suicide. This is a safe drug from a psychiatric perspective."

Jacobs says Accutane can sometimes cause changes in mood, but not "clinical depression."

But critics of Jacobs’ study say an independent analysis is needed. They also say proving a link may be difficult, but it doesn’t mean it’s not there.

Arnot: "How do you explain these cases that are described, at least to us, as normal, healthy, happy teens who, out of the blue, suddenly commit suicide?"

Dr. Jacobs: "These are the phenomena of suicide in young people. We do not have all the answers. Something happens, they commit suicide without warning, without any apparent reason. That is a mystery of suicide that we continue to want to unravel."

But to many dermatologists, there is no mystery about Accutane. The evidence they tend to see in their offices is that Accutane is a near-miracle drug for sufferers of the worst form of acne.

Dr. Hillary Baldwin, a professor of dermatology, says in her 12 years of practice, she’s hardly ever seen a patient complain of depression. In fact, it’s just the opposite.

"I’ve seen patients actually having their psychological effects improved. They’ve started out very depressed, very angry, very frustrated, and now finally they’re getting better," she said.

She says teens coping with the growing pains of adolescence are already at high risk for depression, and if there’s any connection it’s most likely severe acne, not the medication, that may explain what’s going on.

"Many of these patients are severely troubled by the acne from the moment they get up in the morning till the moment they go to sleep at night. So this is a real psychiatric issue for many of these patients. The incidence of depression, of anxiety are way higher in patients who have acne," Baldwin said.

Baldwin has no reservations prescribing Accutane — even with the FDA warnings of depression and suicide. She says as long as she and her patients understand the possible side effects, the benefits of Accutane far outweigh what is still an unproven risk.

But Bart and Laurie Stupak wish they had known then what they do now about the possible risks of Accutane. They say other parents should be aware before their kids begin taking the drug.

"If it can happen to our family, it can certainly happen to you, and we certainly don’t want anyone to have to go through that. If you want to take Accutane, that’s your business, but understand this drug," Bart Stupak said.

"The real tragedy here is B.J. I’m convinced he didn’t want to die. He had no idea that this was going to happen to him. He had too many plans, too much to look forward to. And that’s the real tragedy, and I’m sure there are other tragedies our there, too. Just like B.J.," Laurie Stupak said.

Since the interview, Hoffman-LaRoche told Rep. Stupak in a letter they’re committed to replacing all Accutane packages on the market that do not contain detailed warnings of possible psychiatric risks. They say they still believe there is no link between the drug and depression or suicide.

Accutane is an oral drug prescribed as a last resort for severe cases of acne resistant to other treatments.

"HE WAS just a complete joy. If he was in this room today, he’d light this place up. He had a great personality, he had charm, he had charisma. All the things that all politicians would like to have, he had it. He had it," said U.S. Rep. Bart Stupak (D-Mich.) of his son Bart Stupak Jr.

Earlier this month, the congressman and his wife, Laurie, sat down with the Today Show’s Jamie Gangell to talk about the 17-year-old son they called B.J. — a boy who stunned everyone when he committed suicide last May.

"This is contrary to everything he lived for, everything he thought, everything he wanted to do in life," Bart Stupak said.

An athlete, president-elect of the student council, and popular kid, his friends and family say B.J. had no signs of depression, no family history, no reason they could think of that would cause him to take his own life. In fact, they say, he was planning for his future.

"We had talked about things that he was gonna do the next week. We had just ordered his varsity letter jacket and he had actually gone to the Abercrombie catalogue and marked the things he wanted for his birthday," Laurie Stupak said.

But this year — on Mother’s Day — the Stupaks say something snapped. The last time they saw their son alive was the night before, at his junior prom. To them, he seemed upbeat as usual.

"We told him how good he looked. We were proud of him. He looked sharp that night, and he was just in good spirits, and everything was fine," Bart Stupak said.

The Stupaks let B.J. have an after-prom party at their house while they stayed at a nearby motel. Their older son, Ken, was the chaperon. He and two friends discovered B.J.’s body. He had shot himself in the head with his father’s gun.

"I woke up that morning and everyone was screaming and running around and it was a very frantic situation. And then we went downstairs and, unfortunately, found him there and we were frantic. We couldn’t even believe what happened," Ken said.

There was no note, no explanation. The only unusual behavior that night that’s been reported was, at the party, B.J. took out a Bible and started to read it. He also said because of his grades — a 2.43 average — he wasn’t going to college and that his parents probably hated him for that.

The Stupaks say they were surprised B.J. would say something like that; it didn’t sound at all like their son.

"Completely out of character for him. He would not do something like this," Bart Stupak said.

The Stupaks say they went over every possible explanation. Until one day, when they thought they found their answer: a popular acne medication called Accutane.

"We knew our son. We loved our son. We examined everything. The only thing we can find is Accutane," Bart Stupak said.

Accutane, a cousin of vitamin A, is a last-resort prescription drug. It’s the only one of its kind that cures what’s called severe, nodular acne — acne the size of a pencil-head eraser that leaves permanent, disfiguring scars. It can be a wonder drug to those who’ve used it. But it’s also a powerful drug with potentially serious side effects — the most well-known among them is the likelihood of birth defects if the pills are taken during pregnancy.

B.J. had been taking Accutane for six months before his death. His older brother, Ken, had taken the drug also — with no unusual side effects. The Stupaks say they were aware that the drug could cause changes in mood, but just in terms of psychological side effects, that was all.

"No one ever told us. No doctor. No pharmacist," Bart Stupak said.

And though the congressman is on a House committee with Food and Drug Administration oversight, it wasn’t until the Stupaks checked the Internet that they found FDA warnings from 1998 about Accutane that they say they’d never known about — warnings which included depression, psychosis, and in rare cases, suicide.

"Here’s his prescription. There’s nothing on here. He had one more pill to go," Bart Stupak said. "Nothing about depression. Nothing about suicide ... psychosis. There’s nothing in here."

The maker of Accutane, Hoffman-LaRoche, denies the drug causes those side effects exist and says there’s been no conclusive medical evidence to support the link.

Back in 1998, the FDA looked into 12 suicide cases and felt there was enough cause for concern to ask Hoffman-LaRoche to mention the risk of suicide on the insert that goes out to pharmacists and physicians. The FDA says the insert is something consumers should see, but often times, don’t.

"We were alarmed because we continued to receive reports of depression, of suicide, of suicidal ideation, and some of these other events such as psychosis. We felt even though a causal link hadn’t been established between Accutane and these events, that people should be warned, and that warning should be more prominent," said Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.

In fact, Hoffman-LaRoche has recently changed its label and some packages contain this consumer warning, but many packages still in circulation do not. Bart Stupak says he thinks the FDA has been asleep at the wheel.

"It takes you two and a half years to put a warning on a package. Who ’s watching out? If the watchdog, the FDA, is not watching out for our children and the consumers and the parents, who’s watching out for us?" he said.

The FDA and Rep. Stupak cite anywhere between 44 and 84 reports of suicide and over than a thousand cases of depression, but those are small numbers — less than 1 percent of the 5 million Americans who Hoffman-LaRoche says have taken the drug. Still, the Stupaks believe that few people make the connection and even fewer contact the FDA. Their own son’s death, for instance, was not included in the data.

Perhaps the strongest evidence of a connection between Accutane and depression are reports filed with the FDA that 41 people took Accutane and experienced mood changes or depression. The symptoms then went away when they went off the drug, yet reappeared when they went back on.

Acne treatments are aimed at several factors that play a role in the development of pimples: clogged hair follicles, excess oil production, bacteria and inflammation. Depending on the severity or type of acne, doctors will recommend one or more topical or oral medication. Click on the links above to read about some of the most common treatments.

Benzoyl peroxide — Benzoyl peroxide is applied topically to kill the bacteria associated with acne and help dry the skin. It is usually recommended for mild cases of acne. It is also available in stronger doses with a prescription.

Salicylic acid — Salicylic acid helps cut down the abnormal shedding of cells lining the hair follicles. It also helps unclog pores. It is available in many acne products, including cleansers, lotions, creams and pads.

Sulfur — Sulfur is applied to the skin to unclog pores and help break down blackheads and whiteheads. It is often combined with salicylic acid or resorcinol in medicated creams, ointments and bar soaps.

Resorcinol — Like sulfur, with which it is often used, resorcinol opens clogged pores and helps break down blackheads and whiteheads.

Antibiotics — Antibiotics can be used topically or orally. They fight breakouts by clearing the skin of bacteria. Topical antibiotics, such as clindamycin, are limited in their ability to penetrate the skin and kill bacteria deep in the pores, so they are usually prescribed for less severe cases of acne. Oral antibiotics, such as tetracycline, are usually more effective because they circulate throughout the body and into the oil-producing glands. They are generally reserved for more severe cases of acne after topical treatments have failed, however, because they have more serious side effects, such as reducing the effectiveness of birth control pills and fostering the growth of yeast infections in women.

Retinoids — Vitamin A derivates, called retinoids, can be used topically to help unclog pores by speeding up the shedding of skin layers. Retin-A is probably the best-known retinoid, but since it often causes redness and irritation, two new milder preparations — Retin-A Micro and Differin — are now being prescribed. For very severe cases of acne that haven’t responded to other treatments, Accutane, an oral retinoid that works by shrinking the oil-producing glands, is available. But Accutane carries the potential for serious side effects, including birth defects if a woman becomes pregnant.

Antiandrogens — In some women, acne is caused by over-production of male sex hormones called androgens, which cause excessive oil production. For these patients, the estrogen in birth control pills can help suppress androgen production in the ovaries. Doctors also may prescribe female patients antiandrogen drugs, such as spironolactone, which counteract the hormones’ effects.

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Sources: American Academy of Dermatology, National Institute of Arthritis and Musculoskeletal and Skin Diseases