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Q: Can Psychiatric Meds
Cause Acne?
I was diagnosed about 10 years ago with bipolar. Since then, I have tried Depakote, Remoren, Abilify, Geodon, Zoloft, Paxil, Prozac, Effexor, and
now, I currently take 350 mg of Wellbutrin XL and 100 mg of Seroquel. Ever since
I started taking med's, I have experienced horrible cystic acne. After trying
antibiotics, all kinds of creams/washes/chemical peels/laser treatments, I
decided I wanted to try Accutane. After seeing my dermatologist, she needed me
to get a "letter" of approval from my psychiatrist who was not interested in
doing so. So, after finding a willing dermatologist, I will be starting the
Accutane tomorrow. My issue is this- is it possible that from all of the
psychiatric medications I have been on the past 10 years; has caused my acne? My
psychiatrist can't seem to give me a definite answer. I am extremely frustrated
with having spent thousands of dollars trying to clear up my face (which bothers
me quite a bit) and having nothing work. Accutane seems to be my last resort-
but if the current med's I am on are the cause of my acne than I worry I am
wasting more time and money. I have had my hormones checked, all kinds of
bloodwork done to make sure there are no imbalances that may be causing my acne
and everything has come back negative which leads me to wonder if all of the
med's I have ever taken have caused my acne. I have tried 3 times in the past 5
years or so to wean myself off of the med's to see if maybe they were the cause,
unfortunately I end up getting depressed again and very irritable so I always
end up back on my med's. Any advice would be great, I seem to not be conveying
my agitation with my acne "well enough" for anyone to understand. Thanks so
much.
Dear
Jenny--
I regret that because of a problem in letter-management, my error, this reply is
likely to reach you well after the changes you have asked about have already
taken place, the starting of Accutane. However, let's look at some of the "big
picture" questions you are asking here.
1. Can
some of these medications cause acne? Well, fortunately, perhaps the most famous
psychiatric medication for causing acne is not on your list: lithium. However,
in the last few years (perhaps not when you started it), Depakote -- which is
now available as a generic divalproex, a form of valproate -- has been
recognized to likely be a cause of polycystic ovarian syndrome (PCOS). PCOS can
cause acne.
What is
polycystic ovarian syndrome? Well, I'll bet you're going to go look that up.
You will quickly learn that if you are menstrual cycles are normal, this is
much less likely to be the explanation of your severe acne. Nevertheless, go
ahead and learn more. If you Google PCOS bipolar or PCOS Depakote
you’ll find at the top of the list this page on
PCOS and Depakote. It includes a link to a basic description of PCOS, and
then proceeds to show you the research that made this connection.
While it
would be understandable to be quite angry about having been given a medication
that could possibly have caused or worse and your acne, you will see on that
page I linked above that this story emerged over years, and only recently has
been relatively strongly affirmed. Many psychiatrists have not yet changed
their prescribing practices on the basis of this presumed connection.
By
contrast, none of the rest of the medications on your list has a well-recognized
connection to act any, to my knowledge. I'll bet you could find it on a list of
potential side effects that have been experienced by someone, somewhere, at
least a few times; but they are not famous for this -- certainly not like
lithium.
2. Does
stress, such as the stress of mood symptoms in bipolar disorder, make acne
worse? In other words, and is it possible that the target, rather than the
bullet, is actually involved in this acne problem? I just did some looking
around Pub Med, the search engine for the national Library of medicine, to see
what the literature on stress and Acme shows. Overall, it seems fairly well
recognized that there is some connection, but it is not well understood, nor is
it a very strong factor, at least according to some studies.
3. If
you’re on Accutane now, I hope that’s going well. Of course you’d want to check
in with your psychiatrist early if symptoms are emerging or changing. Good luck
with the process –
Dr. Phelps
Published May, 2009
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