I wouldn't write the theory off..
Tearful parents tell inquest of medication link to suicide
By MARTIN JOHNSTON health reporter
The family of a teenager who committed suicide while taking a common acne drug believe it contributed to his mental state. Hugo Wilkinson, an Auckland University engineering student, took his life in June 2000 when he was 19.
He had been taking isotretinoin capsules, sold as Roaccutane and Oratane, for about three months for severe acne.
His parents, Henrietta and John Wilkinson, are now calling for the Ministry of Health to ban the drug, at present taken by 5000 New Zealanders, or strengthen patient warnings about possible side-effects.
The Remuera couple broke down in tears as they described Hugo's death to Auckland coroner Sarn Herdson.
Ms Herdson yesterday reserved her decision after a two-day inquest.
She took the unusual step of agreeing to a Herald request to report the case, after the family indicated they wanted the hearings public.
But Ms Herdson suppressed details about the manner of death, to avoid copy-cat suicides; and the name of the specialist who prescribed the drug to Hugo.
Isotretinoin's alleged link to suicide is the subject of international scientific debate.
Roche, the pharmaceutical company which developed the drug, derived from vitamin A, says no causal link has been established to psychiatric events.
Roche Products NZ's pharma business manager, Stuart Knight, told the Herald that patients with a severe form of acne had benefited from isotretinoin's "unique efficacy" since it was first sold in 1982.
"Roche has employed a comprehensive post-marketing risk assessment and management strategy to ensure that Roaccutane is used safely and appropriately."
Since 1982, about 12 million patients worldwide, including more than 100,000 in New Zealand, had taken the drug.
But the Wilkinsons' lawyer, Stuart Grieve, QC, indicated to the inquest that the US Food and Drug Administration had criticised a key study Roche relied on.
Auckland Hospital psychiatrist Dr Ian Goodwin, an expert witness called by the coroner, said no independent study had substantiated claims of either side of the debate.
"An identical debate could be entered into over the strength of the evidence that acne, by and of itself, causes depression."
Dr Goodwin, who reviewed Hugo's case, said the teenager had used cannabis occasionally, but there was no history of drug dependence or ideas of suicide.
Roaccutane or cannabis could have been a factor in his mental problems, but there was no evidence that either was a cause.
Last year, ministry-approved patient leaflets from Roche added "suicidal thoughts or tendencies" to the list of health problems patients should tell their doctor about before using the drug.
Studies have found that the drug is associated with severe depression in fewer than 1 per cent of patients, and to mild depression in up to 10 per cent.
Hugo's parents said that on June 16, 2000 - only hours before he died - an appointment was made through the family's GP for him to see a psychiatrist the following week.
Mr and Mrs Wilkinson had become worried about Hugo's mental state after he started taking Roaccutane.
"From that time on, Hugo changed from being a normal, healthy 19-year-old teenager to a withdrawn, introverted and paranoid young man," his father said.
He became slow to answer questions, left his bedroom curtains closed and thought people were watching him.
Hugo was bright, having won an A Bursary in his sixth-form year at Auckland Grammar School, and was a keen rugby player. Before his death he had tidied his room and made his bed.
As Mr Wilkinson went out to watch the All Blacks play that evening, he noticed Hugo had opened his curtains. "As I walked past his window, Hugo waved back and smiled."
That was the last time he saw his son alive.