Hi Pablovi,
Considering adverse reactions to Accutane (isotretinoin), a study in the Journal of Cutaneous Medical Surgery (April 2000, pages 66–70) followed 124 people through their course of treatment reported that "The majority of patients experienced persistent dryness of lips. Dry eyes affected 40% of patients; this continued throughout treatment in 25%. Contact lens wearers were more likely to develop conjunctivitis. Lower back pain was reported early in about 30% of patients and fewer than 10% of patients would develop it later in the course of treatment. Joint pain was noted in 16.5% of patients at the first visit and there was little change with ongoing treatment. Hair loss was experienced in a small percentage but was rarely noted on more than one occasion. Headaches occurred in less than 10% and were occasionally severe, but most often intermittent and recorded at a single visit. Depression occurred in 4% of patients and tended to persist throughout the treatment. All these patients completed the full course of treatment." The study concluded "patients treated with [Accutane] experienced a predictable series of side effects. Some occurred fleetingly, but several persisted for the duration of treatment."
Less common side effects include nausea, vomiting, blurred vision, severe stomach pain, diarrhea, calcium deposits in tendons, and an increase in cholesterol levels.
Regarding nosebleeds while on the drug, these very likely are the result of dry nostrils and not caused by changes in the blood itself. If nosebleeds become problematic, mention this to the dermatologist as steps can taken to reduce them.
As can be seen, some of these side effects could make diving dangerous, e.g., mental disorder; uncomfortable, e.g. dryness of the lips and eyes; or be confused with DCI, e.g., soreness of joints, headache.
Much has been made in some quarters regarding a possible link between Accutane and mental disorder, most notably depression. Fact is such a link has not been conclusively established and the incidence of depression arising during treatment is quite small (~5%). Nonetheless, the FDA has issued a "black box" warning and the reports to date are of enough concern that monitoring for depression is justified.
A good place to begin reading about the issue is the following U.S. Food and Drug Administration-Center for Drug Evaluation and Research alert---->
http://www.fda.gov/cder/drug/InfoSheets/patient/IsotretinoinPT.htm. The advice given there provides a good coverage of signs and symptoms signaling the possibility of mood disorder.
Psychosis has only extremely rarely been reported and when it does occur it appears to be related to a mood disorder rather than a free-standing condition. Signs and symptoms of psychosis include hallucinations, delusional beliefs, personality changes and disorganized thinking. These are usually accompanied by a lack of insight into the unusual nature of the behaviors, difficulties with social interaction and impairments in carrying out activities of daily living.
Certainly any diver showing signs of depression or psychosis should promptly consult a psychiatrist. He or she also should not dive until the signs and symptoms resolve or are brought under excellent control and medical clearance to dive obtained.
Given an adequate topside trial on the drug to rule out side effects that may impact safe scuba, there is no apparent reason that a diver cannot return to diving with his physician's consent.
Since the usual course of Accutane is on the order of 4-5 months, a diver who has serious concerns about its implications for scuba could simply refrain from diving until treatment is completed. These divers will want to be aware that there has been rare report of depression arising shortly after discontinuation of the drug.
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
Regards,
DocVikingo
