Biomarkers & Antidepressants

Hello Dr Ancill,

First and foremost I would like to thank you for putting time and effort in answering this and other questions!

I have a question about bio markers and anti depressants. I have had depressions all my life ever since childhood. Developing louder and different tinnitus than the one i had for a few years triggered another dark episode in my life. I was presribed lexapro by a psychiatrist but I hasitate to take it due to the fact that it may cause even louder tinnitus although I know the chances are small.

After a few weeks I had a follow up appoinment and we talken about the medicins i have taken in the past. Since I had not taken lexapro he suggested I take the medicin I have taken in the past: citalopram. He said that if I did not develop tinnitus in the past with citalopram it will be likely that I will react in the same way now (ten years later). He said I can be quite sure it is safe since scientist can 'predict' the way you respond to medication due to bio-markers.

I also asked the farmacie if I can rely on the fact that I will react the same way to citalopram now as I did ten years ago. They said I could not and that even after a few months of withdrawel one can act differenly on the same medication.

What is your opinion on this matter?

Thanks in advance!

 

This is a great question and, not surprisingly, quite difficult to answer.Firstly, antidepressants have very little ototoxicity, depending on what the cause is of your tinnitus. However, depression will 'amplify' your tinnitus and make it harder to cope with so taking an antidepressants is probably good on balance. In my opinion, citalopram is a pretty useless antidepressant and Lexapro is the better and more active 'cousin'. Secondly, I do not put much stock into so-called biomarkers, which may be useful when studying large populations but usually are not helpful for an individual patient. However, the best thing is to be guided by your own treating psychiatrist. Thirdly, in medicine, history is the best predictor of the future so if you had no problems on citalopram (Celexa) in the past, it is likely you will be OK on citalopram or Lexapro now.