Acne drug may have led to teenager's depression and suicide, court told

By Geesche Jacobsen and AAP October 21, 2004 - Sydney Morning Herald

Profound mood swings ... Sydney schoolgirl Vivian Crane.

A prescription drug a 14-year-old girl was taking for her severe acne might have made her depressed and led the above-average student to kill herself, an inquest has been told.

Vivian Crane, a year 10 student at Roseville Ladies College, became withdrawn when taking Roaccutane to treat her acne, her parents have said. United States consumer warnings state the drug - with the generic name isotretinoin - "may cause depression", but Australian warnings merely advise patients to stop taking it or to see their doctor if they feel depressed or have suicidal thoughts.

But Stephen Rushton, SC, for Roche Products, the pharmaceutical company making the drug, told the Glebe Coroner's Court yesterday there was insufficient evidence that the drug caused depression.

Vivian's mother, Susan Crane, said outside the court her daughter had been lively and animated but her demeanour changed after she began taking the medication. "She told us she had lost the ability to love any of us, she just became a totally different person," she said. Ms Crane told the Herald she had not been warned about the risks of the drugs her daughter had been prescribed. "There should be protocols in place to ensure that the people who choose to take the drug do so in a fully informed manner and are kept safe," she said.

Vivian first took the drug in 1998, at age 12. According to court documents, she became moody at the time, but went back to normal after she stopped taking it. A second course of the drug was prescribed in September 1999 when the acne flared again, and her parents and friends started noticing a change in demeanour. Vivian was taken off the drug when her parents reported symptoms of depression to her doctor in February 2000. She received counselling and was prescribed Zoloft, an antidepressant.

Twelve days before her death she emailed six friends saying she planned to kill herself. Her parents took her to Hornsby Hospital but Vivian was assessed as "not an acute suicide risk" and discharged. She was placed under constant supervision, but on June 8, 2000, her psychiatrist suggested she was improving and no longer needed to be supervised all the time.

Hours before her mother found her dead in her room, she had sent emails to a friend discussing her depression and writing she was no longer taking the prescribed antidepressants.

Mr Rushton said Roaccutane was completely eliminated from the body less than four weeks after being discontinued. He said Zoloft might have contributed to Vivian's depression, and said she also had a family history of mental illness.

He also argued that the psychological effects of acne and difficult family relationships could also have been confounding factors.

He said the Therapeutic Goods Administration reviewed the drug in 2002, and found "the possibility that isotretinoin could cause depression was not proved but a rare effect on mood could not be excluded". About 250,000 Australians have been treated with the drug since it was introduced in 1985, the company said. The deputy coroner is due to hand down her findings in a week's time.