Jonathan Leach said the evidence from experts on a potential link between Isotretinoin and self-harm was that there was “no settled and agreed view”.
St Aidan's C of E High School, Harrogate pupil Annabel Wright was found in her bedroom by family members at her home in Copt Hewick near Ripon, North Yorkshire in May 2019 after being prescribed the drug six months previously.
Mr Leach recorded a conclusion of suicide at a resumed inquest at County Hall in Northallerton today after hearing that the teenager had sent messages to friends on Snapchat saying she was in a low mood and “life is not worth living”.
After her death, police also found a picture Annabel had drawn of Kermit the Frog hanging from a noose.
She had also “scratched” her wrists with a razor in January 2019, shortly after she had been heard laughing on the phone to her friends in her bedroom.
The teenager’s parents believe their daughter’s death was linked to the medication, which is also known as Roaccutane.
The inquest in Northallerton had heard conflicting evidence from two expert dermatologists, Professor Anthony Chu and Dr Sarah Wakelin, on whether the Isotretinoin had contributed to Annabel’s death.
Mr Leach, the assistant coroner for North Yorkshire, said Prof Chu’s assertion that Annabel’s death was linked to taking the Isotretinoin “was clearly outside his level of expertise”.
“Overall, he lacked the objectivity I look for in an expert,” he said.
“In contrast, I find Dr Wakelin to be measured and be prepared to qualify her view and evidence and to say when a question was outside her area of expertise.
“For these reasons where there is a conflict, I prefer the evidence of Dr Wakelin.”
Recording his findings, Mr Leach said: “There is no evidence the balance of Annabel’s mind was disturbed and the fact she took her own life does not in itself mean the balance of her mind was disturbed and, if it was, there is no evidence that this was caused or contributed to by Isotretinoin.
“The only evidence was from Annabel’s parents, who could not concede of any other reason why she would take her own life, and that of Prof Chu, and that part of his evidence was outside of his area of expertise.”
The inquest heard that Annabel saw her GP about her acne at the age of 12 and was later referred to Harrogate District Hospital when she was 14.
Her mother, Helen Wright, told the inquest her daughter had shown no signs of depression and her death “just didn’t make any sense”.
Mrs Wright added: “I wasn’t made aware that suicidal impulses could overcome a perfectly normal person.”
Annabel’s father, Simon Wright, told the inquest: “There was no precursor of depression, mood change, being morose or anything like that.
“Annabel was Annabel and that’s why I believe it was linked.”
The inquest heard that Annabel was seen by two different dermatologists, Dr Ibtessam El-Mansori and Dr Alison Layton, before she was prescribed Isotretinoin.
Dr Layton said she explained “all adverse effects” of the treatment to patients and their parents, including the small risk associated with depression and suicide.
In his findings, Mr Leach said the decision to prescribe Isotretinoin was reasonable and the formal consent process was followed.
“I am satisfied on the question of suicide and a link with Isotretinoin was raised and Dr El-Mansori advised that no causal relationship had been established, and where a suicide occurs there would be other contributory factors.
“I am satisfied the Dermatology Association leaflet was given and she wanted Annabel and Mrs Wright to consider her advice and in the interim period prescribed a different antibiotic.
“I do not accept that Annabel and Mrs Wright were not properly advised about the risks of taking Isotretinoin at all and I find the treatment options discussed and recommended were correct and proportionate.”
Speaking outside court, Simon and Helen Wright said that they 'did not accept' the coroner's findings and criticised him for failing to publish a Prevention of Future Deaths report about the case.
"We are disappointed but not surprised by this outcome. Annabel was let down by Harrogate District Hospital who prescribed her a drug she did not need. She has been let down in life and in death by the authorities' steadfast refusal to accept the role this drug played in her death.
"We know the real truth and that is not changed by the opinions of those who never met her. They have not listened to parents who have lost their children to this drug.
"We we never going to get justice, but we tried to get recognition. There has been wilful ignorance by those who refused to listen. We want to warn other parents that you might not be told about the true side effects of this drug."
Full statement from Annabel Wright's parents and solicitors
"The evidence provided during this inquest has shown that normal, happy, well-adjusted child took her own life, suddenly without warning and without any mitigating circumstances other than that she was taking a drug which can cause suicide. Despite this the coroner has not seen fit to implicate this drug in her death. We are disappointed but sadly not surprised by the conclusion delivered here today.
"Annabel was let down by Harrogate District Hospital when they prescribed her a drug she did not think could cause her suicide. She was let down in life and she has been let down in death by the authorities' steadfast refusal to recognise the role Isotretinoin played in her death. But we, her family, friends and the people he knew her know the real truth this will not be changed by the opinions of those, who never met her, yet have the power to stand in judgement over her.
"We are where we are today because the authorities have not listened to parents who have lost their children to this drug in previous cases. Whatever the conclusion of this inquest it was never going to change anything for us. Annabel, our lovely daughter is dead.
"But in failing to make a PFD report implicating the role Isotretinoin had in her death the coroner has missed a valuable opportunity to try and prevent what happened to Annabel happening to another child, another family. We know we will never get justice for our child but we tried our best to get recognition for the role Isotretinoin played in Annabel's death. In the face of wilful ignorance by those who refused to listen we could do no more.
"In view of this, we, as bereaved parents, would like to take this opportunity to warn others of the dangers of Isotretinoin, because often they will not hear about the true side-effects, including sudden suicidal impulses from those who glibly prescribe it. We hope others will take heed from this tragedy and refuse to allow their children to take this toxic drug."
Senior associate and head of the Hugh James Solicitors inquest team Lynda Reynolds appointed barrister Rory Badenoch QC to ask questions on behalf of the family.
Lynda Reynolds said: “This is such a tragic death, and came completely out of the blue for the family. We have assisted them through the Inquest process which naturally is exceptionally distressing for them. My role was to ensure their voice was heard by the coroner and they could fully participate in the Inquest as to how Annabel came about her death and urge the coroner to consider a Prevention of Future Deaths report.”