roaccutane and SNRIs

[loiloi]

Hi, i've had severe facial acne since i was 11 and am now 31. Tried everything topical, antibiotics and anti-androgens over last 20 years without sucsess which has adversely affected my life and made me v unhappy. Had 2 courses of roaccutane which worked and made me so happy but sadly relapsed. I am so unhappy about my acne i have seen mental health workers and am taking SNRI venlafaxine. My doctor thinks the expected benefit of a third course of roaccutane will outweigh any potential risks. All the proffessionals i have seen agree it is the acne which is causing unhappiness not the roaccutane or venlafaxine. They think that 20 years of acne puts me at greater risk of depression and suicidal idealation than the medication would. Doc says there is no contra-indication taking isotretinoin and SNRIs what do you think? Thanks, Eloise.

[Dr_Jekyll]

Hi Eloise. I think we may have been separated at birth.  I have been on venlafaxine XR 75 mg daily for many years - love it. Just be sure not to miss doses or try to quit taking it without tapering off, as it has a short half-life and, unlike most anti-depressants, can cause withdrawal symptoms after missing only a couple of days.  They're not dangerous, just very noticeable, and confusing if you don't know what's going on. It includes headache, and strange "lightning" or "electrical" sensations that occur for no particular reason (though I notice them more when I turn my head one way or the other). Mind you, these are not side effects of taking the medicine, this just happens if I'm super busy and can't get to the pharmacy and I miss a day or two.  I took Accutane in 2000. It was GREAT! Only bothersome side effect was chapped lips, which responded to cocoa butter lip balm. The dry skin just required a moisturizer. My face was just as oily as ever 2 weeks after stopping the medicine, but I didn't get have any more cystic acne, and hardly EVER got any pimples at all, even without topical acne medication! It was a dream come true... Then, after 5 gloriously clear years, the acne (including the cysts) started to return.  I tried OTC and prescribed topicals all over again, to no avail.  Finally, I took a second course of isotretinoin (generic this time) this year, and it seemed to be working just fine, but now, 3 months later, I am taking minocycline twice daily because ALL of the acne came back (and of course the oil, too).  Personally, my skin produces more oil than a middle eastern country.  I wish I could just stay on Accutane forever (with maybe a year or two off for childbearing).  Alas, I don't believe there is safety data for this, and the monthly blood work would be cumbersome. Anyway, if the topical Retin-A and the oral antibiotics stop working, I'll likely go for a 3rd course of Accutane, but this time, I will insist on brand-name (not sure if the second course was less effective because it was generic, but I don't wish to take chances next time). I hope all goes well for you.  -Samantha

[loiloi]

Thanks so much for your comments. I've posted several times regarding accutane and mental illness and was surprised that nobody responded sooner, given the much debated issue of whether it causes depression or whether the acne does. Did you ever take the venlafaxine and accutane at the same time as each other? Eloise x

[loiloi]

Hey Samantha, I suspect we have a time difference (I'm in UK) but do get back to me about whether you took the accutane and venlafaxine together.  I would also be interested to hear from anyone who suffered depression after Accutane. Mine started after my second relapse from accutane, when the spots came back worse than ever before. Has anyone suffered depression even though their accutane treatment resulted in a complete cure of their acne, and if so what did your negative feelings center around? Or did you all feel depressed because your accutane treatment was ineffective or the remission short, ie that the acne caused the low mood rather than the accutane?