But substantial noncompliance with the PPP continues to be reported. For example, a 1997 report on the survey shows that 25 percent of women in the program did not report having a pregnancy test before starting Accutane, and 33 percent did not report postponing the start of Accutane until a pregnancy test result was known. It is estimated that 40 percent of women taking Accutane are sexually active. The only patients exempt from Accutane's contraceptive requirements are men, and women who have had a hysterectomy or who say they will abstain from sex during treatment. But the challenge is that going from sexually inactive to active can happen overnight.
Many patients say they feel better about themselves after receiving successful treatment for acne.
Evelyn Germanakos, of Los Angeles, Calif., struggled with acne as an adult, and says she felt like her old self after Accutane cleared up lumpy blemishes in 1997. But while Accutane may help lift psychosocial distress such as embarrassment, evidence suggests that it may actually cause serious psychiatric disorders in some people. Though the drug's label previously listed depression as a possible reaction, FDA strengthened the label warning in 1998 after reviewing cases with serious outcomes reported in the years after the drug was approved. The label also advises providers that simply discontinuing the drug may not remedy any psychiatric problems and that further evaluation may be necessary. Psychiatric treatment may also be needed.