CLINICIANS maintain that there is no conclusive link between suicide and the acne drug Isotretinoin despite the parents of a teenage girl saying it ‘undoubtedly’ led to her death.

Annabel Wright died aged 15 at her home near Ripon on May 1, 2019.

In the six months leading up to her death she had been taking the anti-acne drug Isotretinoin – whose brand name is Roaccutane – and an inquest has heard that she took her own life despite having no history of mental health problems or depression.

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Her devastated parents Helen and Simon, who described Annabel as a happy, bright and sociable teenager, believe that the drug caused her suicide.

They also believe that Annabel’s acne, which was graded as three out of ten on a clinicians’ severity scale, was not severe enough to warrant being treated with Isotretinoin.

The inquest has also heard that there are studies that draw a link between Isotretinoin and increased suicide risk, although the research has been described as ‘conflicting’.

Speaking after the second day of the hearing held at Northallerton Coroners’ Court today, Annabel’s mum Helen said: “What has become abundantly clear these last two days is that dermatologists are treating patients presenting with mild acne with a drug which is licensed for use in the most severe cases of acne, despite the known risks of suicide as acknowledged by the MHRA (Medicines and Healthcare products Regulatory Agency), the British Association of Dermatologists and the drug manufacturers themselves.

“This course of action has undoubtedly led to the death of our beloved daughter.”

The Northern Echo:

Simon and Helen Wright, Annabel's parents speaking outside Northallerton Coroners' Court

The inquest heard today from medical professionals who had either treated Annabel themselves or were experts in dermatology.

Nurse Susan Cameron assessed the youngster at the specialist acne clinic at Harrogate Hospital three times during her acne treatment, including an appointment on the day of her death.

During each appointment Annabel was asked a series of questions about her mood and Ms Cameron said that no concerns were ever raised about her mental wellbeing.

She described their final meeting to the court, saying: "I recall that she was happy, she was smiling, we had a bit of banter about various answers (to a wellbeing questionnaire).

"I asked her again how her mood was, was she feeling down or fed-up, to which she replied she was fine.

"There were no problems."

Professor Alison Layton is consultant dermatologist at the Harrogate acne clinic who also assessed Annabel during her treatment.

She reiterated that there were no concerns about Annabel's mental health during her treatment but did concede that she may have stopped the Isotretinoin had she been told about a self-harm incident whereby Annabel cut herself with a razor blade in late January 2019.

Prof Layton said: "Self-harm is very common in adolescents, about 25 per cent of 14 to 17 year old girls have self-harmed.

"But being on Isotretinoin and being aware there are issues perhaps, although never proven, I would be very cautious.”

Asked whether the drug was the cause of Annabel's suicide, Prof Layton said she could not answer because she wasn't a psychiatrist.

She said that there do exist reports of children taking their own lives without any prior history of depression or warning signs and who were not taking Isotretinoin.

"I think it leaves us with an unanswered question," she said.

Prof Layton accepted that there were reports linking Isotretinoin to suicides, but there said was no conclusive proof of a causal link and that there were many conflicting studies.

She said: "In the course of my practice I have not seen any trends to suggest there is a problem."

When asked if Annabel and her parents were made sufficiently aware of the potentially dangerous side-effects of the drug, Prof Layton said they were given 'a measured overview' of the risks of Isotretinoin.

She added: "We are treating a vulnerable group, there have been a lot of case reports, there are conflicting publications about it and the MHRA are reviewing things at the moment.

"But at the time I was seeing Annabel, there was no evidence to link Isotretinoin with causes of suicide."

Dr Sarah Wakelin, a consultant dermatologist at Imperial College Healthcare Trust, spoke as an expert witness.

She said it was her view that throughout Annabel's monitoring the appropriate questions about her wellbeing were asked and there was no indication that she was clinically depressed.

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Dr Wakelin said there 'was no hard and fast conclusion' that Isotretinoin was linked to depression but discussions about self-harm, low mood and the possibility of behaviour change should always be had with patients because there had been case reports of people on Isotretinoin committing suicide.

Dr Wakelin praised the positive results of the drug in treating acne and said it would have been appropriate to prescribe it to a patient who had been on antibiotics for a year with limited results, as in Annabel's case.

She said: "It is an extremely effective drug, I think most dermatologists would agree it is unparalleled in its efficacy."

Under questioning by the family's lawyer, Rory Badenoch, about the link between suicide and Isotretinoin, Dr Wakelin reiterated the fact that no conclusive link had been drawn.

She said: "It is by no means certain that the drug causes adverse psychiatric effects. "

The inquest will resume in early December.

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