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Family of Suicide Victim Learns His Acne Treatment Lists Suicide As Side Effect

Sep 27, 2005 | Linton Daily Citizen

Tammy and David Hestand of rural Bloomfield are concerned that a prescription acne medication may have contributed to the suicide of their 17-year-old son, Caleb.

"He had the world at his feet," Tammy said. "He had a beautiful life with everything going for him. Then on August 28th he committed suicide with no warning.

"We talked to his friends, our pastor and we can't come up with anything else. Things were good with his girlfriend, his job, his friends. He had a car and money for dates. He was focusing on West Point. He had more freedom than he'd ever had. He had a great summer."

The young man, who would soon have been 18 and was a senior at Bloomfield High School, had an admissions appointment at the United States Military Academy at West Point and was excitedly preparing his paperwork. He was heavily involved in Junior ROTC, participated in track and field, and was in honor society, according to his parents. He planned to study chemical engineering at West Point.

"He was mature and responsible and always on a straight line," Tammy said.

"There wasn't a morning of his life that he didn't wake up and ask 'What can I do for you, Mom?' "

He was a modest kid who voluntarily helped others, as well, the Hestands found out at his funeral service. They said people they didn't even know approached them to say how Caleb had helped them in various ways, such as weeding an elderly person's lawn or bringing an elderly lady her newspaper.

The Hestands said they truly believe everything was fine with Caleb right up to the morning of his death and that his suicide was not planned. David said his son had told his girlfriend he'd be over to help her with her algebra the day he killed himself, and he'd recently invested $2,000 in a gaming computer.

"Things like that just don't make sense," David said.

After Caleb's death, Tammy found an insert for his acne medication, Accutane®, which is marketed by Roche. She was disturbed at what she read.

"One whole side of the insert is dedicated to psychiatric events," she said, adding that she looked up more about it on the Internet.

"I think the most disturbing thing was story after story like ours just change the name.

"Pretty much the overall defense of the pharmaceutical company was that these kids were so deformed by acne that they were suicidal before."

Depression, psychosis (seeing or hearing things that aren't real), thoughts of suicide, and suicide are listed as possible side effects of Accutane®. According to the MICROMEDEX® Healthcare Series, other potential side effects include everything from dry eyes to Crohn's Disease, hearing loss to violent or aggressive behavior, kidney disease to dry, brittle skin, nails and hair. Bruising, chest pain, hyperglycemia, hyperthyroidism, abnormal lipids, increased or decreased appetite, inflammatory bowel disease, ulcerative colitis, nausea and vomiting, pancreatitis, anemia, bleeding, hepatitis, tendonitis, arthritis, arrested growth, muscle damage, headache, confusion, lethargy and fatigue, watery eyes, conjunctivitis, cataracts, night blindness, sexual dysfunction, bronchospasms, and respiratory infections are among other symptoms documented in users of isotretinoin, which is the chemical name for Accutane®. Birth defects, miscarriage and other pregnancy-related risks also are indicated with isotretinoin use.

Once the primary patent on Accutane® expired, other companies came out with their own bioequivalent versions. Sotret®, by Ranbaxy Pharmaceuticals; Claravis, by Barr Laboratories; and Oratane®, by Douglas Pharmaceuticals, are examples. Tammy believes this has made it easier for patients to afford and, therefore, it's prescribed more often.

"You had to have systemic cystic acne to get it at first," she said. "Now kids with a few pimples are getting it. It's much easier now."

Isotretinoin is recommended for severe nodular or cystic acne that's been unresponsive to conventional therapies, including antibiotics. Shelley Rosenstock, executive director for public affairs at Roche, defines cystic or nodular acne as a "chronic (long-term) condition in which painful, disfiguring, fluid- or pus-filled cysts form under the skin of the face, neck, chest and back." She said the risk of scarring is significant. Isotretinoin provides "complete and prolonged remission" for acne. In other words, it clears it up pretty much permanently.

"Accutane® isotretinoin and its generic versions are the only approved and effective treatment for severe cystic or nodular acne that has not responded to other treatments," Rosenstock said. "Healthcare providers worldwide have used it for 23 years to help more than 14 million patients."

She explained that acne is a disease of the hair follicle unit consisting of the hair shaft, hair and oil (sebum) gland. Acne occurs from the interaction of several different factors, including increase in sebum production, obstruction of the hair follicle caused by abnormal cell production, overgrowth of a specific bacteria, and inflammation resulting from the leakage of sebum, bacteria, and other cells into the lower layers of skin. In severe nodular acne, these factors combine to cause nodules, or inflamed lesions, that can be painful and may result in scarring if left untreated, she said.

Isotretinoin treats this form of acne by four different mechanisms, according to Rosenstock. It reduces sebum production by 60 percent to 80 percent; restores proper balance of cell growth and eliminates stickiness in the hair follicle; significantly reduces bacteria on the skin and in the hair follicle; and reduces immune response in the skin by about 98 percent. Normal levels and responses return after treatment, she said.

"The effect of the way the product works usually prevents the acne from returning," Rosenstock added.

Tammy said a dermatologist recommended Accutane® for Caleb, explaining that it was a last resort and that it was controversial. She said he told them about the birth defects and liver issues, but said he was confident in giving it to Caleb. She said her son had to have fasting liver tests before his appointments with the doctor every four weeks.

The Accutane® did clear up Caleb's acne, and there were no noticeable side effects, she said. The only thing they noticed was an uncharacteristic lapse of judgment a couple times during the summer. They chalked it up to feelings of empowerment that come with the freedom teens gain when they hit a certain age.

"I have to give it credit," Tammy said. "It was a miracle drug. His skin was beautiful."

After Caleb's death, she said, the doctor told her he checked Caleb's file to be sure he'd asked him about depression and suicidal feelings. He had, and Caleb had denied any of those feelings. The doctor told Tammy that he'd prescribed Accutane® for 20 years without a problem. Then why, she wondered, did he check Caleb's file when he learned of the teen's death?

Filing an Accutane lawsuit against Roche will not bring Tammy’s son back, but it can make many of those who are on Accutane think of refusing from  such a dangerous acne treatment.

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