Medical student's suicide after taking acne drug Coroner calls for 'clear warnings' on skin remedy

Laura Barton Wednesday October 20, 2004

The Guardian

A promising medical student killed himself four weeks after being prescribed a controversial acne drug, an inquest in Manchester heard yesterday.

Jon Medland, 22, was in the final year of his medical degree at Manchester University when he hanged himself at his student lodgings early on January 13 this year. Leonard Gorodkin, the Manchester coroner, was told that in a short time Mr Medland had been transformed from a "bubbly, outgoing" young man with a love of student life and Manchester United to becoming withdrawn and depressed with suicidal thoughts.

Mr Medland had suffered from mild acne for several years, but the inquest heard that he had become self-conscious about dealing with patients. By last autumn he had tried three different types of antibiotic and various topical treatments, and although he had noticed some improvement in his skin, the acne had not cleared. Through his own research, Mr Medland had learned of the drug Roaccutane, used to treat more severe cases of acne. Mr Medland was referred by his GP to Dr Haydn Muston, consultant dermatologist at Withington Hospital, Manchester, and attended his first appointment on December 11.

Dr Muston told Mr Gorodkin that it was not standard practice to prescribe treatment at the initial appointment, but as Mr Medland was a medical student and had already researched the possible side-effects of the drug, he wrote him a prescription that day. "I felt Jon wanted to get started," he said. Mr Medland went home to Devon for Christmas, where his family and his girlfriend noticed nothing unusual about his behaviour, the hearing was told. It was only once he had begun a placement at a medical practice in Shrewsbury on January 5 he began to complain of feeling tired and stressed, and had doubts about his academic abilities.

He told friends and family that he feared his mental state was somehow connected to the Roaccutane, and that he had "read somewhere" that the effects might not cease when he stopped taking the drug. They told him to stop taking the Roaccutane tablets, which he did on January 8. The inquest heard that the following day he returned to Manchester where his flatmates noticed that he was uncharacteristically quiet. He began acting strangely and told them he had been experiencing suicidal thoughts.

Though Mr Medland had been due to see Dr Muston for a follow-up appointment that week, his flatmates urged him to see his GP, which he did on January 12, and was prescribed the anti-depressant Citalopram. The following day, Mr Medland's flatmate found him dead in his room. Recording a verdict that Mr Medley killed himself, Mr Gorodkin said: "For a drug to affect a person of a very solid life foundation, if it can lead them to take their own life, then it deserves further investigation, if a link can be proved. "But I cannot say with any certainty that the effects of the drug Roaccutane led him to take his own life. All I can say is that the warnings that are already present should be made very clearly and strongly."

Earlier this year, European medicine watchdogs announced a review of Roaccutane's safety record, following concern regarding alleged links to suicide and depression. The drug's manufacturer, Roche, says that 13 million people worldwide have used Roaccutane, and although it is not possible to say how many of these are in Britain, by last January an estimated 375,000 treatment courses may have been prescribed.