Sunday, March 5, 2017

Accutane Not Linked to Depression, Study Says


A small study fails to link the use of the controversial acne drug Accutane to severe depression or suicide. The findings are reported in the May issue of the journal Archives of Dermatology.

For years, critics have said Accutane can cause serious depression and increase suicide in teens. A U.S. congressman blames the drug for his teenage son's suicide five years ago, as does a Florida mother whose 15-year-old son died in 2002 after intentionally flying a small plane into a Tampa, Fla., skyscraper.

But the drug's manufacturer has long contended that Accutane does not increase the risk of depression and suicide, and a newly published study appears to back that up.

Teens in the study who took the drug showed far fewer signs of depression three and four months after beginning treatment than they did before starting Accutane.

"This certainly backs up what we have seen in our practices," pediatric dermatologist Elaine Siegfried, MD, tells WebMD. "Most dermatologists are in agreement that Accutane is a miracle drug for acne. I have treated many thousands of patients with it, and I have never seen clinically significant mood alterations in any of my treated patients."

Known Risks

accutaneAccutane was approved in 1982 for the treatment of serious acne that doesn't respond to other treatment. Its safety has been the subject of heated debate ever since. A synthetic derivative of vitamin A, the drug is well known to cause serious birth defects in up to a third of babies born to women who use it during pregnancy.

As a result, women of childbearing years who take Accutane are required to use at least two forms of birth control while on the drug.

But while Accutane has long been suspected of causing depression, there is no direct proof to back up the claim, says psychiatrist Douglas G. Jacobs, who is a consultant to the drug's manufacturer, Roche Labs. Roche is a WebMD sponsor.

"I have spent more time reviewing the studies than anyone and there is just no evidence that Accutane causes depression or increases the risk of suicide," Jacobs tells WebMD.

A statement published earlier this month by the FDA notes that the agency continues to assess reports of suicide or suicidal attempts associated with the use of Accutane. The statement also calls on physicians to be vigilant about following their patients taking the drug closely for signs of depression.

The latest study was conducted by Siegfried and colleagues from St. Louis University Health Sciences Center without financial backing from Roche Pharmaceuticals.

The researchers used standardized tests to evaluate depression levels among teens with moderate to severe acne -- before beginning Accutane and while on the drug. Another group of teens who took antibiotics instead of Accutane for their acne were also evaluated.

Roughly 14 percent of the teens in the Accutane group and 19 percent of those in the antibiotic group had scores suggestive of depression before beginning treatment. Three to four months later about 8 percent of the teens taking Accutane and 15 percent of those taking antibiotics had similar scores.

Siegfried says it just makes sense that teens who feel better about the way they look will be less depressed.

"I have seen it over and over in my practice," she says.

Brain Imaging Studies

But Emory University psychiatrist J. Douglas Bremner, MD, who also studies Accutane, says the latest study was too small to answer many questions about whether Accutane causes depression. Of the 132 patients enrolled, 59 were treated with Accutane and 73 were prescribed antibiotics and topical creams.

Bremner says a study of at least 1,000 patients is needed to either prove or disprove the link between Accutane and depression.

The psychiatrist says his own recent imaging research shows that Accutane causes changes in the frontal lobe of the brain, which is associated with emotion. The research was published last month in the American Journal of Psychiatry.

Bremner found significant changes in the area of the brain known as the orbitofrontal cortex in 13 adults taking Accutane. No such changes were seen in a similar number of adults taking antibiotics.

But a Roche spokeswoman tells WebMD there is no consensus in the scientific community that the orbitofrontal cortex of the brain controls depression and mood. She added that there was no difference in depression symptoms between the people in Bremner's study taking Accutane and those taking antibiotics.

All the Evidence They Need lack of clinical proof has done nothing to change the views of those who blame Accutane for the suicide of a loved one.

Rep. Bart Stupak (D-Mich.) is among the drug's most outspoken critics. Stupak's 17-year-old son, B.J., shot himself in May of 2000, and Stupak says he believes Accutane is responsible. The legislator has been working to get tighter controls on Accutane ever since.

The mother of a teenager who killed himself by flying a Cessna airplane into a Florida high-rise office building in January 2002 is also convinced that Accutane caused her son's death.

And a grieving father in Ireland has reportedly spent more than $1 million of his own money attempting to prove that Accutane is linked to suicide. Liam Grant's 19-year-old son, also named Liam, took his own life in 1997 while studying engineering at Dublin University.

The elder Grant is now suing Roche and hopes to force the drug company to release confidential information about Accutane.


Tuesday, January 31, 2017

Exercise is medicine - but how much of a dose do we need?


For 10 years, the American College of Sports Medicine has been trying to convince a sedentary public that exercise is medicine, as good for what ails us as over-the-counter or prescription pills.

What began as a national campaign morphed into a global initiative, with the goal of getting physicians to prescribe exercise to their patients and suggest that they get "physical activity counseling."

But although the association between exercise and health is widely accepted, there seems to be no consensus on how much physical activity we need for optimal health. The World Health Organization recommends 2? hours a week. A study funded by the Bill and Melinda Gates Foundation last year recommended five times that amount. And now there's new research suggesting that people who exercise only on weekends can reap significant health benefits.

While the studies seem contradictory, they have one thing in common: They conclude the more exercise you do, the healthier you'll be — up to a point.

Finding that sweet spot for you and your family can greatly reduce the chance that you'll get one of five common diseases. But if you're currently unable to run six hours or swim eight hours a week, the new findings on "weekend warriors" will at least encourage you to do what you can for the time being. But be careful — occasional exercise comes with its own set of risks.

Attention, weekend warriors

The "weekend warrior" study published Jan. 9 in the journal JAMA Internal Medicine has gotten lots of buzz for its promise of longer life with sporadic effort. The authors said that weekend-only exercise and "insufficient activity" patterns can cut mortality by 30 percent.

"Many midlife people with active family lives and burgeoning careers find it difficult to make time for regular workouts. As a result, fitness advocates often encourage a small-steps approach to exercise," wrote Amby Burfoot, winner of the 1968 Boston Marathon, in The Washington Post.

"Don’t be discouraged if you don’t have the time to train for a half-marathon, they advise. Focus on what you can do, not what you can’t. Anything is better than nothing. The new research seems to confirm this," Burfoot wrote.

That could be heartening to the estimated third of Americans who get no exercise at all, or those who fall into an exercise drought and despair of losing fitness and momentum.

Researchers analyzed the weekly exercise reported by 63,000 British and Scottish adults and found both the ones who worked out once or twice a week for 2? hours or more and the ones who exercised just an hour were both around 30 percent more likely to outlive the completely sedentary.

But one subset of people fared even better: Those who exercised three or more times a week.

"These individuals tended to go longer and slower than less-frequent exercisers but logged impressive weekly totals of about 450 minutes. They had a 35 percent lower all-cause mortality rate," Burfoot explained.

That's similar to what a public-health researcher in Australia recommended in a report published last year.

Dismissing the recommendations of the World Health Organization as insufficient, the study concluded that we need five times that amount to significantly cut our risk of five types of disease: breast and bowel cancer, diabetes, heart disease and stroke.

“Although the first minutes of activity do (the) most for health, our research results suggest activity needs to be several times higher than current World Health Organization recommendations to achieve larger reductions in risks of these diseases,” lead author Lennert Veerman, of the University of Queensland, said in a statement.

His advice translates into exercise sessions that would be staggering for most people: 15 to 20 hours of brisk walking per week, 6 to 8 hours of running, 7 hours of cycling and eight hours of swimming.

Working with researchers at the University of Washington and Dartmouth College, Veerman analyzed 174 studies published between 1980 and 2016 and compared activity levels with the incidence of disease. Using a measure called "Metabolic Equivalent of Task" — or MET — he assigned values to minutes of vigorous activity, light activity or doing nothing.

As The Huffington Post explained, "Most health gains occur at a total activity level of 3000-4000 MET minutes a week which equals 12.5 to 16.5 hours of brisk walking or 6 to 8 hours of running a week."

But in their study, published in the journal BMJ, the researchers advocated not just for repeated, sustained periods of vigorous exercise, but also picking up the pace of everyday activities and chores.

"Focusing on a particular domain such as leisure-time physical activity, which represents only a small fraction of total activity, as was done by most studies, restricts the scope of applicability of the findings in the real world by limiting the opportunity of increasing activity in different domains in daily life (such as being more physically active at work, engaging more in domestic activities such as housework and gardening, and/or engaging in active transportation such as walking and cycling)," the authors said. "Taking into account all domains of physical activity increases opportunities for promoting physical activity."

While it's a problem that relatively few Americans have, there is some evidence that you can exercise too much.

Take it slow

In his memoir "What I Talk About When I Talk About Running," the novelist Haruki Murakami wrote that when people criticize him, "I go running for a little longer than usual. By running longer it's like I can physically exhaust that portion of my discontent."

As Murakami knows, in addition to offering protection from disease, vigorous exercise has been shown to have psychological benefits, such as quelling anxiety and reducing depression. Physical activity also treats ADHD and seems to slow cognitive decline as people age.

But despite the many benefits, weekend warriors should remember that sporadic physical activity can come with a cost: increased soreness at the first of the week, plus the possibility of injury.

A 2014 study found increased risk of serious injury among weekend-only athletes, although the author was uncertain whether it was because the exercisers were more easily fatigued or stressed, or just that they weren't as experienced those who worked out more frequently.

Moreover, physical exertion stresses the heart, which can lead to catastrophe if people try to do too much too soon. Recently in Thailand, where government leaders have been ordered to exercise for 90 minutes every Wednesday, a Bangkok official collapsed and died during an afternoon football game. And every year in the U.S., a few runners with preexisting conditions die from the stress of road races. And extreme amounts of exercise can lead to a condition called "athlete's heart," in which the heart becomes dangerously enlarged.

It's clear, however, that exercise benefits both mind and body in increments as little as 10 minutes, building gradually to an hour or more every day. A widely accepted rule of thumb is to increase your physical activity no more than 10 percent every week.