The zitty face of depression

Drugs for depression and drugs for acne don't always mix well.

By Cynthia Kuhn - Wilkie Wilson

Published October 4, 2000 7:00PM (EDT)

Dear Buzzed,

I have pimples all over my face. Can I take Accutane to clear up acne caused by lithium?

Broken Out

Dear Broken Out,

First of all, we are happy that you are being conscientious about taking your lithium. Lithium can dampen the mood swings people with manic-depressive illness experience -- the feeling of one moment being euphoric, the next in deep depression. However, you have to take lithium every day to experience this mood-stabilizing effect. Unfortunately, lithium has many side effects, including nausea, sleepiness, excessive urination, weight gain, changes in the thyroid gland, and -- you guessed it -- bad acne. Some people stop taking the drug for these reasons alone. But quitting lithium can be life threatening. A manic or depressive incident can often follow, so it's important to speak with a physician before altering your regimen.

Lithium works because it affects crucial chemicals in your brain. It has so many side effects because it also affects similar enzymes in the rest of your body. This medication can make it harder for your kidney to concentrate your urine, so many end up having to run to the bathroom all the time. Similarly, lithium probably affects skin chemicals in the same way, and this makes your face break out.

Unfortunately, Accutane (isotretinoin) may be not be the right treatment for your acne. While it is the most effective medicine available to clear up cystic acne, it has been associated with the development of depression in about 1 percent of patients who take it. There is one case report in the medical literature of a bipolar patient who was doing well, but started experiencing mood problems when she took Accutane to treat acne, although we can't be sure that Accutane actually caused the mood problems. Some psychologists argue that mood changes result when people's acne clears up, but their life problems don't!

You should consider talking with your doctor about other alternatives for treating your acne or taking other drugs for treating your mood problems. There are several other drugs, like carbamazepine (Tegretol) and valproate (Depakane or Depakote) that are effective in treating bipolar illness and do not have the severe potential side effects that lithium has. Women should know that if they get pregnant while taking Accutane, there is a very high chance that their baby will be born with serious birth defects. The manufacturer takes this so seriously that it requires women who want to start on the medicine to take a pregnancy test first.

By the way, it might surprise you to know that interactions between the skin and the mind are not at all unusual. First and foremost, people can get depressed because their acne is so bad. But psychiatrists have also speculated that getting stressed can make skin diseases -- including eczema, alopecia (total loss of body hair), psoriasis and dermatitis -- worse. Sometimes when people are very stressed, they pick at their skin and cause the skin damage themselves.

It's best to discuss your particular case with a psychiatrist or dermatologist. It is critical that he or she know of all the medicines that you are taking so there are no interactions. You should be able to find a combination that better suits both your mood and your face. Good luck!

Buzzed appears every Wednesday in Salon Health. Do you have a question? We would love to hear from you. Contact us at buzzed.

Cynthia Kuhn

Cynthia Kuhn, Ph.D., is a professor of pharmacology at Duke University Medical School and heads the Pharmacological Sciences Training Program at Duke. She is coauthor of "Buzzed: The Straight Facts About the Most Used and Abused Drugs From Alcohol to Ecstasy" and of the forthcoming book "Pumped: Straight Facts for Athletes About Drugs, Supplements and Training."

MORE FROM Cynthia Kuhn

Wilkie Wilson

Wilkie Wilson, Ph.D., is a professor of pharmacology at Duke University Medical School. He studies how drugs affect the brain, particularly the processes of learning and memory. He is also coauthor of "Buzzed" and of the forthcoming book "Pumped."

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