Our expert says:
Interesting question, G. And you wisely allude to the range of components of such a possible association which good research into the matter would need to try to address. Usually, as I think happened in this case, people start to notice an apparent association between two things --- here, between taking Roaccutane and marked Depression. That such an association does occur seems pretty clear. But there are many associations, and the naure of the actual association is what then needs to be established.
Is it CAUSAL --- in other words, does A CAUSE B, or are both caused by something else ? As you point out, Roacutane is not supposed to be used frivolously, so in a sense the use of Roacutane is "caused" by having a chronic severe and dispiriting condition, as nobody takes it for fun. SO are Roaccutane and Depression both caused by having terrible acne ?
And the other qustion you raise, also highly relevant is : is the apparent association real, or caused by severe acne and thus the drug's use being most common in an age-group already, for several reasons, significantly at risk for Depression. I don't think anyone can deny that part of the risk is likely to be due to the age and risk-group to which people likely to be advised to use Roaccutane belong, and part due to the miseries of the condition for which they take it. My personal impression from the literature I have seen is that in addition to this, there is probably also a contributory risk due to the drug itself. Such an effect from a range of other drugs is well established and recognized.
But as in other such cases, such a drug can be valuable and well-used, with vigilance being applied, to watch for early signs of the possible development of a Depression, and early treatment of it. Maybe having a psych assessment before starting would be a useful precaution, and, if notable elements of depression are present, starting CBT type counselling could be valuable in a therapeutic and preventive sense.
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