Q: My teenage son has acne and I just picked up his Accutane (isotretinoin) from the pharmacy. I’ve been reading on the Internet about it, and now I’m worried about starting him on it. His skin isn’t that bad. Can it really cause suicide?

- K.S. in

Tulsa, Okla.

A: Possibly, but so many factors contribute to suicide, you can’t exclusively blame a drug in every case. Still, the devastation to families affected by this medication can be horrific.

Some drugs can cause psychosis, as evidenced by seeing or hearing things that aren’t really there, behaving strangely and experiencing paranoia or delusional thinking.

Accutane and its generic, isotretinoin, can alter mood, and the manufacturer, Roche, openly shares this information. Other brand names include Amnesteem, Claravis and Sotret. These drugs, synthetic derivatives of vitamin A, can negatively impact brain chemicals such as dopamine and serotonin. An Accutane package insert warns of: “depression, psychosis and rarely, suicidal ideation, suicide attempts and suicide.”

Statistics show that between 1989 and 2003, there were 216 reported drug-linked suicides among U.S. teens younger than 18. Of these, 72 suicides were linked to Accutane (isotretinoin). The next highest number of suicides in that time period - 55 - involved Prozac (fluoxetine).

The FDA Web site warns: “All patients treated with isotretinoin should be observed closely for symptoms of depression or suicidal thoughts, such as sad mood, irritability, acting on dangerous impulses, anger, loss of pleasure … mood disturbance, psychosis, or aggression.”

Psychiatric side effects tied to vitamin A are nothing new. As early as 1856, the Arctic explorer Elisha Kane noted psychiatric symptoms in men who ate polar bear liver, later found to contain large amounts of vitamin A. In the last 150 years, case reports of psychosis, schizophrenia and suicide associated with too much vitamin A and vitamin A-derived pharmaceutical drugs have increased substantially.

Parents deserve to know everything about isotretinoin (and all drugs) because their children’s lives may depend on how well they are informed.

Even if your child is off isotretinoin, keep watching him closely because adverse effects may occur several months after discontinuation. Remember, stopping a drug that alters brain chemicals does not mean the brain chemicals magically become balanced again.

Last warning: Isotretinoin-type drugs cause birth defects and are not often prescribed for sexually active women of childbearing age. And no one should ever share this medication with friends.

Suzy Cohen is a registered pharmacist. To contact her, visit http://www.dearpharmacist.com.