Trióna and Ed Enright are at their home in Coolmain, west Cork, looking at a photo of a memorial plaque to their daughter Anne.
Anne was the eldest of the couple’s three daughters and the picture they paint is of an outgoing, chatty, hugely popular teenager who seemed to be enjoying life to the full when tragedy struck.
“Anne had just qualified as a lifeguard,” recalls Ed. She also played camogie “but she probably loved the social aspect more than the playing. She was into fashion … she had a summer job at an adventure centre here in Kilbrittain, the West Cork Secret.”
His wife Trióna adds: “She loved school, I used to tell her to stop studying she was studying so much – she wanted to be a dietitian and had just started fifth year and was loving it because transition year didn’t suit her at all but at the same time she wasn’t a bit nerdy – she could have the craic.”
She died by suicide, aged just 16, on September 17th, 2024.
Her death for the family came out of the blue after a summer of fun. She was out at festivals, Longitude and others, that year and had the summer of her life, recalls her mother.
Like many adolescents, Anne had developed acne, appearing first when she was just 11. Her mother, a pharmacist at Cork University Hospital, says it was treated first with over-the-counter creams, then prescription antibiotics after visits to their GP. It would improve, only to worsen again later.
“Anne’s acne would flare up and down, but it was at its worst during Christmas of fourth year and was starting to cause her distress – it was all over her back and she had the TY [transition year] Ball, so we got a referral to a consultant dermatologist in Dublin,” says her mother.
The consultant prescribed Roaccutane and her mother remembers well the conversation she had first with the consultant and later with Anne about going on the drug and the risks associated with it. Trióna recalls the consultant spoke about side effects such as dry skin and bleeding lips, and “mood changes” were mentioned, but Trióna’s only concern was the risk of suicide.
Anne Enright
“I was very conscious about the risks with Roaccutane because when I qualified in 1999 there were all these cases coming out and a black box warning, the highest level of drug warning in the US, so it was always on my radar and Anne and I had a big chat about it on the way home.
“We spoke about it all the way from the Red Cow [M50 roundabout in Dublin] to Tipperary, and I remember saying to her, ‘Anne, suicide is forever’ so we did talk about it seriously, but she was so happy to be going on it because she knew it worked for most people.”
Anne had come off Roaccutane five days before she took her own life. She was found by her sisters Kate, then aged 13, and Tessa, then aged nine. She had an older half-sister Emma.
Since her death Trióna and Ed Enright have rigorously researched Roaccutane.
Trióna accepts that, while all acknowledge there is an association between Roaccutane (isotretinoin) and mood changes, the issue of whether there is a causal link between the drug and depression, attempted suicide and suicide is unproven.
Nonetheless, she remains convinced that it was going on the drug and then possibly coming off it that led to her daughter’s decision to end her life. She points to a line on a patient information leaflet about Roaccutane available on Ireland’s Health Products Regulatory Authority (HPRA) website.
In a section warning about “Mental Problems”, under a heading stating “Very rare effects (may affect up to 1 in every 10,000 people)”, the leaflet states: “Some people have had thoughts about hurting themselves or ending their own lives (suicidal thoughts), have tried to end their own lives (attempted suicide), or have ended their lives (suicide). These people may not appear to be depressed.”
Following an inquest into Anne’s death last summer, the coroner Frank O’Connell decided to notify the HPRA that the student had died days after coming off a six-month course of isotretinoin for acne.
He said there was no hard evidence linking her death to the medication but “it would be remiss of this court not to refer the case to the HPRA as there are known and recognisable risks associated with this medication”.
“The regulatory authorities need to know about this,” said O’Connell as he returned a verdict of “death by suicide in a 16-year-old with no known previous relevant history but in the immediate aftermath of a six-month course of isotretinoin for acne”.
In August the HPRA issued a drug safety newsletter saying adverse psychiatric reactions to such drugs continued to be reported. “This includes cases of completed suicide associated with isotretinoin,” it said, adding it was reiterating its warning to healthcare professions to be aware of the importance of discussing “potential psychiatric risks with patients before, during and, in the case of isotretinoin, after treatment”.
Since the beginning of 2021, the authority has been notified of 10 suspected adverse reaction reports “describing mental health problems, including anxiety, stress, depressed mood/depression and negative thoughts, following treatment with Roaccutane (which contains the medicine isotretinoin),” a spokesman said.
A portrait of Anne Enright at her home in west Cork. Photograph: Chris Maddaloni
“Of these reports, a small number describe suicide. Please note that when the relevant number is less than five, it is described as a small number to avoid any potential, inadvertent identification of the individuals concerned.
“While it was not possible to determine whether Roaccutane had a causal role in these cases, the HPRA has issued safety communications to reinforce awareness among healthcare professionals of the existing warnings and advice relating to the risk of psychiatric adverse reactions with isotretinoin and other oral retinoid medicines,” he added.
Following reports in the UK that 10 suicides had been linked to the drug in 2019, an expert safety review found in April 2023 the benefits of the treatment for severe acne outweighed the risks but recommended patients and their families receive better information about the risks of isotretinoin.
The exact number of prescriptions for Roaccutane issued in Ireland each year are not known but dermatologists who spoke to The Irish Times on background said they prescribed it thousands of times each year. It is a common treatment option.
The Health Service Executive said there had been “reports of people experiencing mood changes while taking isotretinoin” but “there’s no proof that these were because of the medicine”.
If a patient on the drug feels depressed, anxious or aggressive or has suicidal thoughts, they should “contact your GP immediately”, it said.
Trióna and Ed Enright at the Coláiste na Toirbhirte secondary school in Bandon, where there is a memorial bench and garden in memory of their daughter Anne. Photograph: Chris Maddaloni
Carsten Brandt, spokesman for German company Cheplapharm, which has made Roaccutane in Europe since 2024, said they were deeply saddened to learn of Anne’s death, extended sympathy to her family and stressed “the safety of our patients is our top priority”.
“We continue to work closely with regulatory authorities worldwide to monitor and evaluate all safety data related to our product. Due to patient confidentiality we cannot comment on individual cases, but we take all reports seriously and thoroughly investigate them in line with regulatory requirement.”
For Trióna Enright, the line in the manufacturer’s leaflet that people on Roaccutane may not appear depressed is “frightening” as it suggests parents and family can be as vigilant as she was for signs of depression or suicidal ideation and there simply may be no such signs to notice.
“Anne was constantly telling me how happy she was to be on it. Because of that I never thought something like this could happen, certainly without me noticing some change in her and there was no change.
“I know the literature on Roaccutane and suicide isn’t conclusive, and we don’t want to be scaremongering, but this is our experience. It’s not everybody’s experience but we can’t ignore what happened our daughter and we just want people to go into this with their eyes wide open as to the risks. We don’t want any other family to experience the nightmare we’re going through.”
For support: Samaritans on freephone 116 123 or text HELLO to 50808. Pieta freephone: 1800 247 247 or text HELP to 51444. Or visit yourmentalhealth.ie
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