Consumption and ocurrence of antidepressants (SSRIs) in pre- and post-COVID-19 pandemic, their environmental impact and innovative removal methods: A review

Non-targeted identification of tianeptine photodegradation products in water samples by UHPLC-QTOF MS/MS

This study aims the characterization of several tianeptine transformation products in ultrapure water by simulated sunlight irradiation. Tianeptine was completely degraded after 106 h of exposition following pseudo-first-order kinetics (half-life time = 12.0 ± 2.4 h). Furthermore, an ultra-high-performance liquid chromatography coupled with a high-resolution quadrupole time-of-flight-mass spectrometry method was developed and fully validated taking into account different method performance parameters for the quantification of tianeptine in river water up to a concentration of 400 pg L-1. Following a non-targeted approach based on mass data-independent acquisition, eight different transformation products not previously reported in the literature were identified and accordingly elucidated, proposing a photodegradation mechanism based on the accurate tandem mass spectrometry information acquired. Irradiation experiments were replicated for a tianeptine solution prepared in a blank river water sample, resulting in the formation of the same transformation products and similar degradation kinetics. In addition, a toxicity assessment of the photoproducts was performed by in silico method, being generally all TPs of comparable toxicity to the precursor except for TP1, and showing a similar persistence in the environment except for TP2 and TP6, while TP4 was the only TP predicted as mutagenic. The developed method was applied for the analysis of four river water samples.

Predicting the potential risks posed by antidepressants as emerging contaminants in fish based on network pharmacological analysis

This study conducted a network pharmacology-based analysis to simultaneously discern a broad spectrum of potential environmental risks and health effects of antidepressants, a common class of pharmaceutical emerging contaminants (PECs) possessing a complex pharmacological profile, and in silico predict the adverse phenotypes potentially occurring in fish associated with exposure to antidepressants and their mixtures under realistic exposure scenarios. Results showed that 24 of the included 39 antidepressants had been detected worldwide in water environment across 50 countries. Using the environmentally realistic exposure scenario for China as an example, the predicted blood concentrations of antidepressant residues that were generated based on the Fish Plasma Model ranged from 37.89 (Alprazolam) to 16,772.05 (Sertraline) ng/L in exposed fish. Hazard-based bioactivity network without regard to concentration data was composed of 148 potential targets and 701 antidepressant-target interactions. After filtering each antidepressant-target interaction node using the predicted drug concentrations in the blood of fish under realistic exposure scenarios in China, an environmental risk-based network was refined and showed that 11 targets, including muscarinic acetylcholine receptor M1, alpha-2B adrenergic receptor, serotonin 2 A receptor, etc. might be modulated by antidepressants at concentrations equal to or below the environmental exposure levels and their mixtures in fish. Environmentally relevant concentrations of antidepressants in water samples from China might perturb the behavior, stress response, phototaxis, and development in exposed fish.

Impact of chronic fluoxetine exposure on zebrafish: From fatty acid profile to behavior

The consumption of antidepressants, such as fluoxetine, has increased over the years and, as a result, they are increasingly found in aquatic systems. Given the increasing use of zebrafish as an animal model in toxicological studies, this work proposed to evaluate the effects of chronic exposure, for 21 days, to fluoxetine at environmentally relevant concentrations (1, 10, 100, and 1000 ng/L). The behavioral tests performed did not reveal significant effects of fluoxetine. However, oxidative stress and changes in energy metabolism were detected after exposure to the highest concentrations of fluoxetine tested, namely a decrease in glutathione S-transferase (GST) activity (decrease of ca. 31%), increase in catalase (CAT) activity (increase of ca. 71%), and decrease in lactate dehydrogenase (LDH) activity (decrease of ca. 53%). Analysis of the fatty acid profile (FA) revealed a decrease in the omega-3 FA, docosahexaenoic acid (DHA), C22:6 (decrease in relative abundance between 6% and 8% for both the head and body), an increase in omega-6 FA, linoleic acid (LA), C18:2, (increased relative abundance between 8% and 11% in the head and between 5% and 9% in the body), which may suggest changes in the inflammatory state of these organisms. The integrated analysis adopted proved to be useful in detecting subindividual effects of fluoxetine and modes of action in fish.

Integrated physio-biochemical and transcriptomic analysis reveals the joint toxicity mechanisms of two typical antidepressants fluoxetine and sertraline on Microcystis aeruginosa

Selective serotonin reuptake inhibitor (SSRI) antidepressants are of increasing concern worldwide due to their ubiquitous occurrence and detrimental effects on aquatic organisms. However, little is known regarding their effects on the dominant bloom-forming cyanobacterium, Microcystis aeruginosa. Here, we investigated the individual and joint effects of two typical SSRIs fluoxetine (FLX) and sertraline (SER) on M. aeruginosa at physio-biochemical and molecular levels. Results showed that FLX and SER had strong growth inhibitory effects on M. aeruginosa with the 96-h median effect concentrations (EC50s) of 362 and 225 μg/L, respectively. Besides, the mixtures showed an additive effect on microalgal growth. Meanwhile, both individual SSRIs and their mixtures can inhibit photosynthetic pigment synthesis, cause oxidative damage, destroy cell membrane, and promote microcystin-leucine-arginine (MC-LR) synthesis and release. Moreover, the mixtures enhanced the damage to photosynthesis, antioxidant system, and cell membrane and facilitated MC-LR synthesis and release compared to individuals. Furthermore, transcriptomic analysis revealed that the dysregulation of the key genes related to transport, photosystem, protein synthesis, and non-ribosomal peptide structures was the fundamental molecular mechanism underlying the physio-biochemical responses of M. aeruginosa. These findings provide a better understanding of the toxicity mechanisms of SSRIs to microalgae and their risks to aquatic ecosystems.

Covid-19 psychological distress: Analysis of antipsychotic drugs' use in an Italian population sample

BACKGROUND

The current pandemic, in addition to putting a strain on healthcare systems and global economies, has exacerbated psychiatric problems and undermined the mental health of many individuals. In an Italian cohort, this phenomenon has been assessed through a retrospective study aimed at evaluating the consumption and costs of antipsychotic drugs between 2020 and 2022.

METHODS

All dispensations made in local pharmacies accessible to the public have been extracted from a database called 'Sistema Tessera Sanitaria', which covers a population of approximately one million people residents in the ASL Napoli 3 Sud. Consumption data expressed in defined daily dose (DDD) and expenditure data expressed in Euro have been extrapolated.

RESULTS

The results in the years 2020-2021 were relatively consistent, with consumption and expenditure decreasing slightly from 2020 to 2021. In 2022, the results showed a decrease in consumption and expenditure (2,706,951.07 DDD and €1,700,897.47) representing the reduced accessibility of patients to the healthcare facilities due to the pandemic. However, it should be noted that the antipsychotic drug aripiprazole showed an upward trend, registering an increase in consumption.

CONCLUSION

Despite expectations of increased consumption of antipsychotic medications, real-world evidence indicated a different phenomenon, with the pandemic seemingly not affecting the consumption of these drugs. The difficulty in accessing care and medical appointments has probably influenced this data, masking the therapeutic needs of citizens. It will be necessary to assess in the coming years, as normal clinical activity resumes, whether there will be a growing consumption of these medications, which represent one of the main expenditure categories for the National Healthcare System.

Utilization of antidepressants, anxiolytics, and hypnotics during the COVID-19 pandemic

Since the onset of the COVID-19 pandemic, there have been concerns over the mental health impact of COVID-19. This is a review of the utilization of antidepressants, anxiolytics, and hypnotics since the COVID-19 pandemic was declared on March the 11th 2020. A number of reports so far have been based on large prescription databases for administrative use at the national or regional level, but mainly in high-income countries. We found studies reporting increased prescription rates of antidepressants, anxiolytics, and hypnotics during March 2020, which has been interpreted as hoarding of such medications. In the following months, most studies of antidepressant prescription rates did not display a clear pattern of change compared with prepandemic trends. In later phases of the pandemic small increases in utilization of antidepressants, with higher than predicted prescription rates, have been the most consistent finding, especially in youth. In most high-income countries, there were increasing trends in utilization of antidepressants also before 2020, which needs to be considered when estimating utilization during the pandemic, whereas for anxiolytics and hypnotics, the prepandemic patterns of prescriptions were more varying. Overall, after March 2020 we could not find any distinct changes in the utilization of anxiolytics and hypnotics during the COVID-19 pandemic. Most studies did not contain information about the prevalence of indicated psychiatric disorders in the studied populations. More studies are needed about the long-term effects of COVID-19, particularly regarding utilization of antidepressants. Research relating antidepressant utilization with the prevalence of major depression and anxiety disorders would promote a better understanding of how well antidepressant prescription rates reflect the needs of the population.

Assessing Pharmacokinetic Correlates of Escitalopram-Related Adverse Drug Reactions

BACKGROUND

To assess the pharmacokinetic correlates of reported adverse drug reactions (ADRs) under antidepressant treatment with escitalopram (ESC) using a large therapeutic drug monitoring database.

METHODS

A large naturalistic sample of inpatients and outpatients prescribed ESC was analyzed. ADRs were classified using the Udvalg for Kliniske Undersogelser side effect rating scale. We compared ESC-treated patients with (n = 35) and without ADRs (n = 273) using ESC plasma concentrations as the primary outcome. We also compared ADR rates in the 2 groups based on 2 cut-off ESC levels reflecting the recommended upper thresholds of the therapeutic reference range of 80 ng/mL, suggested by the consensus therapeutic drug monitoring guidelines, and 40 ng/mL, based on recent meta-analysis data. The effects of age, sex, smoking, daily ESC dose, plasma concentrations, and concentrations corrected for daily dose were included in a binary logistic regression model to predict ADRs.

RESULTS

No differences in clinical, demographic, or pharmacokinetic parameters were observed between patients with and without ADRs ( P > 0.05). Patients with ESC-related ADRs were more frequently diagnosed with psychotic disorders than those without (25% vs. 7.1%, P = 0.004). None of the variables was associated with ADR risk. Overall, ADR rates were not significantly different in patients above versus below thresholds of ESC concentrations (ESC concentrations >40 [n = 59] vs. ≤40 ng/mL [n = 249] and >80 [n = 8] vs. ≤80 ng/mL [n = 300]; P = 0.56 and P = 1.0, respectively).

CONCLUSIONS

No distinct pharmacokinetic patterns underlying ESC-associated ADRs were observed. Further studies with more specific assessments of ADRs in larger cohorts are required to better identify potential underlying patterns.

Sub-chronic exposure to paroxetine disrupts ecologically relevant behaviours in fish

The functional conservation of important selective serotonin reuptake inhibitor (SSRI) targets in non-target organisms raises concerns about their potential adverse effects on the ecosystems. Although the environmental levels of SSRIs like paroxetine (PAR) have risen, the knowledge regarding the effects of long-term exposure to PAR is limited. This study investigated the impact of sub-chronic exposure (21 days) to two sub-lethal concentrations of PAR (40 and 400 μg/L) on the behaviour of adult zebrafish in different scenarios: basal activity (under dark and light conditions), stress response (evoked by sudden light transitions) and stress response recovery. A new framework was employed for the integrative study of fish's swimming performance based on their innate ability to respond to light shifts. Several swimming-associated parameters (e.g., total swimming distance, time of inactivity, swimming angles) and thigmotaxis were monitored for an integrated analysis in each scenario. Data revealed reduced swimming activity, impaired behavioural response to stress and alterations in stress recovery of PAR-exposed fish. An anxiolytic effect was particularly noticeable in fish basal swimming activity in the dark at 400 μg/L and in the behavioural response to stress (from dark to light) and stress recovery (from light to dark) for organisms exposed to 40 μg/L. The detected PAR-induced behavioural modifications suggest a disruption of brain glucocorticoid signalling that may have implications at the individual level (e.g., changing behavioural responses to predators), with potential repercussions on the population and community levels. Therefore, the applied protocol proved sensitive in detecting behavioural changes induced by PAR.

Pharmacokinetic correlates of clinical response in a naturalistic sample of escitalopram-treated patients

OBJECTIVE

We assessed pharmacokinetic correlates of treatment response to escitalopram using a large therapeutic drug monitoring database.

METHODS

A large naturalistic sample of patients receiving escitalopram was analyzed. Responders were defined as 'very much improved' or 'much improved' based on the Clinical Global Impression - Improvement score, CGI-I. We compared responders (n = 83) vs. non-responders (n = 388) with the primary outcome being the escitalopram plasma concentration and concentration corrected by the daily dose (C/D ratio). Effects of age, sex, body-mass-index (BMI), and C/D ratio were assessed in a multivariate logistic regression model predicting response.

RESULTS

There were no statistically significant differences in clinical and demographic characteristics between responders vs. non-responders. There were also no differences between escitalopram daily doses or plasma concentrations, while C/D ratios were significantly higher in non-responders than in responders (1.6 ± 1.7 vs. 1.2 ± 0.9 (ng/mL)/(mg/day), p = 0.007); C/D ratios (odds ratio 0.52, 95% confidence interval 0.34-0.80, p < 0.003) were associated with response to escitalopram, after controlling for age, sex, and BMI.

CONCLUSIONS

Patients with low clearance of escitalopram as reflected upon high C/D ratios may be less likely respond to escitalopram. Identifying these patients during dose titration may support clinical decision-making, including switching to a different antidepressant instead of increasing daily dose.

Safety Profile of Selective Serotonin Reuptake Inhibitors in Real-World Settings: A Pharmacovigilance Study Based on FDA Adverse Event Reporting System

BACKGROUND

Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed agents to treat depression. Considering the growth in antidepressant prescription rates, SSRI-induced adverse events (AEs) need to be comprehensively clarified.

OBJECTIVE

This study was to investigate safety profiles and potential AEs associated with SSRIs using the Food and Drug Administration Adverse Event Reporting System (FAERS).

METHODS

A retrospective pharmacovigilance analysis was conducted using the FAERS database, with Open Vigil 2.1 used for data extraction. The study included cases from the marketing date of each SSRI (ie, citalopram, escitalopram, fluoxetine, paroxetine, fluvoxamine, and sertraline) to April 30, 2023. We employed the reporting odds ratio and Bayesian confidence propagation neural network as analytical tools to assess the association between SSRIs and AEs. The Medical Dictionary for Regulatory Activities was used to standardize the definition of AEs. AE classification was achieved using system organ classes (SOCs).

RESULTS

Overall, 427 655 AE reports were identified for the 6 SSRIs, primarily associated with 25 SOCs, including psychiatric, nervous system, congenital, familial, genetic, cardiac, and reproductive disorders. Notably, sertraline (n = 967) and fluvoxamine (n = 169) exhibited the highest and lowest signal frequencies, respectively. All SSRIs had relatively strong signals related to congenital, psychiatric, and nervous disorders.

CONCLUSIONS AND RELEVANCE

Most of our findings are consistent with those reported previously, but some AEs were not previously identified. However, AEs attributed to SSRIs remain ambiguous, warranting further validation. Applying data-mining methods to the FAERS database can provide additional insights that can assist in appropriately utilizing SSRIs.

Electrochemical degradation of key drugs to treat COVID-19: Experimental analysis of the toxic by-products formation (PCDD/Fs)

Drug consumption has grown exponentially in recent decades, particularly during the COVID-19 pandemic, leading to their presence in various water sources. In this way, degradation technologies for pollutants, such as electrochemical oxidation (ELOX), have become crucial to safeguard the quality of natural resources. This study has as its starting point a previous research, which demonstrated the efficacy of ELOX in the removal of COVID-19 related-drugs, such as dexamethasone (DEX), paracetamol (PAR), amoxicillin (AMX), and sertraline (STR), using the electrolytes NaCl and Na2SO4. The present research aims to study the potential risks associated with the generation of toxic by-products, during the ELOX of cited drugs, specifically focusing on the highly chlorinated persistent organic pollutants (POPs), such as polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). Dioxins and furans can be formed potentially in electrochemical systems from precursor molecules or non-precursor molecules in chloride medium. First, the degradation of the parent compounds was found to be complete. At this point, a comprehensive investigation was conducted to identify and analyse the by-products formed during the degradation process; precursors of PCDD/Fs, such as chlorophenols or hydroquinones were identified. Additionally, in continuation of the previous study, PCDD/Fs congeners were investigated, revealing elevated concentrations; the highest concentration obtained was for the congener 1,2,3,4,6,7,8-HpCDF (234.6 pg L-1 in NaCl) during degradation of the AMX. Finally, an assessment of the toxicity based on TEQ values was conducted, with DEX exhibiting the highest concentration among all compounds: 30.1 pg L-1 for NaCl medium. Therefore, the formation of minor by-products should not be underestimated, as they can significantly enhance the toxicity of the final sample, so the selection of the appropriate remediation technology, as well as the optimization of experimental operating variables, is determining in the treatment of pharmaceutical-contaminated waters.

Antidepressants in wastewater treatment plants: Occurrence, transformation and acute toxicity evaluation

Antidepressants (ATDs) are one of the most prescribed medications for psychiatric conditions. The widespread presence in aquatic environment and demonstrated ecotoxicity make ATDs a class of concerning emerging contaminants. Municipal wastewater treatment plants (WWTPs) provide important connecting channel between wastewater and aquatic environment. Herein, we present a critical overview of the occurrence, transformation and toxicity of typical ATDs during water treatments. The total concentration of the detected ATDs and their metabolites in the WWTP influents and effluents are 72.62-5011.80 ng/L and 114.48-6992.40 ng/L, respectively, on a global scale. The frequently observed negative removal of ATDs in WWTPs indicates that some ATDs exist as conjugates in wastewaters. The biotic and abiotic transformation of ATDs and the generated transformation byproducts (TPs) were identified, which occurred in WWTPs worldwide along with ATDs. Acute toxicity of ATDs and their TPs was predicated using the ECOSAR model. Compared to ATDs, the demonstrated enhanced toxicity of several TPs to aquatic organisms necessitates more attention on TPs monitoring in WWTPs. This work provides scientific support for wastewater advanced treatment to alleviate ATDs pollution in effluents.

Retrospective spatiotemporal study of antidepressants in Slovenian wastewaters

This study utilizes wastewater-based epidemiology (WBE) to evaluate spatiotemporal changes in the consumption of antidepressants before and during the COVID-19 pandemic in Slovenia. Composite 24-h influent wastewater samples (n = 210) were collected from six wastewater treatment plants between summer 2019 and spring 2021. The samples were extracted using 96-well solid-phase extraction and analysed by liquid chromatography-tandem mass spectrometry. The measured concentrations of target antidepressant biomarkers were then converted to population-normalised mass loads (PNMLs), taking into account flow rate and catchment population. Ten biomarkers, including amitriptyline, bupropion, bupropion-OH, citalopram, norcitalopram, normirtazapine, venlafaxine, O-desmethylvenlafaxine, trazodone, and moclobemide, were above the lower limit of quantification and were included in the spatiotemporal temporal assessment. The highest PNMLs were detected for O-desmethylvenlafaxine (mean ± SD: 82.1 ± 21.2 mg/day/1000 inhabitants) and venlafaxine (38.0 ± 10.6 mg/day/1000 inhabitants), followed by citalopram (27.0 ± 10.7 mg/day/1000 inhabitants). In addition, the mean metabolite/parent compound ratios were comparable with other WBE studies indicating consumption rather than direct disposal. Overall, the results indicated significant spatiotemporal variations depending on the location, and the PNMLs of most biomarkers increased during the first wave of the COVID-19 pandemic (spring of 2020). However, no clear spatial patterns were revealed related to the pandemic.

Poor regulation, desperation, and misinformation, a countrywide analysis of self-medication and prescription patterns in Ecuador during the COVID-19 pandemic

BACKGROUND

The rapid spread of the SARS-CoV-2 virus during the early phase of the pandemic led to an unprecedented global health crisis. Various factors have influenced self-medication practices among the general population and unsubstantiated prescribing practices among healthcare professionals.

OBJECTIVE

This study aimed to describe trends in the purchase and sale of medicines during the COVID-19 pandemic period (2020-2022) in Ecuador, by comparing them with pre-pandemic periods.

METHODS

In this study, a cross-sectional design was employed to conduct a comprehensive analysis of 28 pharmacological groups, categorized according to the Anatomical Therapeutic Chemical Classification (ATC). Utilizing an integrated drug consumption database, the study examined physician prescribing data, medicine usage, and spending levels in Ecuador during the COVID-19 pandemic. The analysis involved computing absolute differences in monthly resolution, calculating excessive expenditure in comparison to previous yearly averages, and using Defined Daily Dose (DDD) methodology for internationally comparable results. Furthermore, a correlation analysis was performed to investigate potential associations between prescribed and consumed medicines and the number of new cases and deaths.

RESULTS

In Ecuador, the average yearly expenditure among these groups prior to the pandemic (2017-2019) amounted to $150,646,206 USD, whereas during 2020 and 2021, the same groups represented a total expenditure of $228,327,210, reflecting a significant increase. The excess expenditure during this period reached 51.4%, equivalent to $77,681,004 USD. Notably, 13% of this expenditure consisted of Over the Counter (OTC) Medicines. The study also identified a remarkable surge in sales of ivermectin, which increased by 2,057%, and hydroxychloroquine, which increased by 171%, as measured by DDD.

CONCLUSIONS

This study highlights the substantial consumption of medicines by the population in Ecuador during the pandemic. It is concerning that many medications were sold without proven therapeutic indications, indicating that misinformation and desperation may have led to improper prescribing by physicians and patients resorting to ineffective drugs. Moreover, since the sale of these therapeutic drugs requires a prescription, poor regulation, and a lack of control within pharmacies likely contributed to such practices.

Unraveling the combined toxicity and removal mechanisms of fluoxetine and sertraline co-contaminants by the freshwater microalga Chlorella pyrenoidosa

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (FLX) and sertraline (SER), are among the most widely detected pharmaceuticals in aquatic environments, and they usually occur as mixtures. However, little is known about the combined toxicity of SSRI mixtures to microalgae and the associated removal mechanisms. This study investigated the combined toxicity of FLX and SER to the growth, photosynthetic activity, and antioxidant system of Chlorella pyrenoidosa and their removal mechanisms. The results showed that FLX and SER strongly inhibited microalgal growth with 96 h EC50 values of 493 and 61.1 μg/L, respectively. Additionally, the combined toxicity of FLX and SER towards microalgal growth exhibited an additive effect. After 4 days of short-term exposure, FLX, SER, and their mixtures caused photosynthetic damage and oxidative stress in microalgae, and the mixture's toxicity was stronger than those of individuals. However, the adverse effects on microalgal growth, photosynthetic activity, and antioxidant system were alleviated with increasing exposure time. Meanwhile, C. pyrenoidosa efficiently removed FLX (67.59%-99.08%) and SER (94.92%-99.11%) individually after 11 days of cultivation. Biodegradation (59.25%-86.21%) was the prominent removal mechanism of FLX, while both biodegradation (48.08%-88.17%) and bioaccumulation (4.74%-43.38%) contributed significantly to SER removal. The co-existence of FLX and SER lowered the removal rate and biodegradation amount of both compounds. Besides, SER inhibited C. pyrenoidosa's N-demethylation and O-dealkylation of FLX, while co-existing with FLX inhibited the excretion of the N-deamination product of SER from microalgal cells. Furthermore, the principal component analysis indicated that the removal performance of FLX, SER, and their mixtures correlated strongly to the microalgae's physiological and biochemical states. These results highlighted the significance of co-contamination during ecological risk assessments and microalgae-based bioremediation of SSRIs.

Are early and young life stages of fish affected by paroxetine? A case study with Danio rerio

Paroxetine (PAR) is a selective serotonin reuptake inhibitor (SSRI) antidepressant increasingly detected in surface waters worldwide. Its environmental presence raises concerns about the potential detrimental effects on non-target organisms. Thus, this study aimed to increase knowledge on PAR's potential environmental impacts, assessing the effects of commercial formulation (PAR-c) and active ingredient (PAR-a) on fish. Therefore, the short-term exposure effects of PAR-c and PAR-a were assessed on zebrafish (Danio rerio) embryos/larvae to determine the most toxic formulation [through median lethal (LC50) and effective concentrations (EC50)]. PAR-c and PAR-a induced morphological abnormalities (scoliosis) in a dose-dependent manner from 96 hours post-fertilization onwards, suggesting the involvement of a fully functional biotransformation system. As PAR-c exhibited higher toxicity, it was selected to be tested in the subsequent stage (juvenile stage), which was more sensitive (lower LC50). PAR-c significantly decreased fish swimming activity and disrupted fish stress response. Overall, the results highlight the ability of PAR-c to adversely affect fish swimming performance, an effect that persisted even after exposure ceases (21-day depuration), suggesting that PAR-c may impair individual fitness.

Effect of common low-molecular-weight organic acid on the photodegradation of sertraline by ferrihydrite

Sertraline is one of the most commonly used antidepressant pharmaceuticals with ubiquitous distribution in the aqueous environment. However, the environmental behavior of sertraline in the co-presence of low-molecular-weight organic acid (LMWOA) and iron oxide mineral is still poorly understood. In this study, the photodegradation of sertraline was systematically investigated in a common photosensitizing system (ferrihydrite (Fh)-LMWOA). Six LMWOAs, including citrate acid (CA), tartrate acid (TA), malate acid (MA), lactate acid (LA), succinate acid (SA) and malonic acid (MOA) were chosen as the representatives. Our results implied that the different Fe3+ dissolution rates would lead to rather different sertraline degradation patterns following the order of Fh-CA > Fh-TA > Fh-MA > Fh-LA > Fh-SA > Fh-MOA. The reaction was initiated by the interaction between LMWOA and Fh via ligand-promoted-dissolution mechanism. Furthermore, the Fe3+ dissolution rates also showed a strong correlation with the metal-organic complexation constants, indicating that the photodegradation process is strongly related to the complexation ability of LMWOA with Fe3+. •OH, O2•- and CO2•- were detected, indicating that they contributed to the photodegradation of sertraline. •OH was demonstrated to be the dominant Reactive oxygen species (ROS) for the degradation of sertraline, and the detailed transformation pathways were proposed based on the product analysis and theoretical calculation. According to the ecological structure activity relationship estimation, the photodegradation products of sertraline possessed lower toxicity compared to the parent compound. These findings contribute to a more comprehensive understanding of the environmental fate of sertraline and evaluate its potential ecotoxicity in natural systems.

Evaluation of adsorption performance and mechanisms of a highly effective 3D boron-doped graphene composite for amitriptyline pharmaceutical removal

Three-dimensional heteroatom-doped graphene presents a state-of-the-art approach for effective remediation of pharmaceutical wastewater on account of its distinguished adsorption and physicochemical attributes. Amitriptyline is an emerging tricyclic antidepressant pollutant posing severe risks to living habitats through water supply and food chain. With ultra-large surface area and plentiful chemical functional groups, graphene oxide is a favorable adsorbent for decontaminating polluted water. Herein, a new boron-doped graphene oxide composite reinforced with carboxymethyl cellulose was successfully developed via solution-based synthesis. Characterization study revealed that the adsorbent was formed by graphene sheets intertwined into a porous network and engrafted with 13.37 at% of boron. The adsorbent has a zero charge at pH 6 and contained various chemical functional groups favoring the attachment of amitriptyline. It was also found that a mere 10 mg of adsorbent was able to achieve relatively high amitriptyline removal (89.31%) at 50 ppm solution concentration and 30 °C. The amitriptyline adsorption attained equilibrium within 60 min across solution concentrations ranging from 10 to 300 ppm. The kinetic and equilibrium of amitriptyline adsorption were well correlated to the pseudo-second-order and Langmuir models, respectively, portraying the highest Langmuir adsorption capacity of 737.4 mg/g. Notably, the predominant mechanism was chemisorption assisted by physisorption that contributed to the outstanding removal of amitriptyline. The saturated adsorbent was sufficiently regenerated using ethanol eluent. The results highlighted the impressive performance of the as-synthesized boron-doped adsorbent in treating amitriptyline-containing waste effluent.

Exploring the association between selective serotonin reuptake inhibitors and rhabdomyolysis risk based on the FDA pharmacovigilance database

Rhabdomyolysis is a syndrome potentially fatal and has been associated with selective serotonin reuptake inhibitors (SSRIs) treatment in a few case reports. Herein, we purpose to establish the correlation between SSRIs use and rhabdomyolysis using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. We conducted an analysis on reports that were submitted to the FAERS database during the period between January 1, 2004, and December 31, 2022. Four algorithms, including reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and empirical Bayes geometric mean (EBGM), were employed to quantify the signals of rhabdomyolysis associated with SSRIs. In total, 16,011,277 non-duplicated reports were obtained and analyzed. Among 33,574 reports related to rhabdomyolysis, SSRIs were classified as primary suspected drug in 889 cases. Disproportionality analysis identified a positive signal between rhabdomyolysis and SSRIs (ROR: 2.86, 95% CI 2.67-3.05; PRR: 2.84, χ²: 1037.16; IC_0.25 = 1.39; EBGM_0.5 = 2.64). Among six SSRIs, fluvoxamine had the strongest signal (ROR: 11.64, 95% CI 8.00-16.93; PRR: 11.38, χ²: 265.51; IC_0.25 = 2.41; EBGM_0.5 = 8.31), whereas no significant signal of rhabdomyolysis was detected for paroxetine (ROR: 1.83, 95% CI 1.55-2.15; PRR: 1.82, χ²: 53.82; IC_0.25 = 0.73; EBGM_0.5 = 1.59). After excluding cases co-administered with statins, the signal of rhabdomyolysis associated with SSRIs remains significant. Our analysis reveals that there are differences in safety signals among six SSRIs in respect to the risk of rhabdomyolysis, with fluvoxamine displaying the highest risk signal, while paroxetine did not show a significant signal. Given the potentially lethal nature of rhabdomyolysis, healthcare professionals should inform patients of the potential risk of rhabdomyolysis associated with SSRIs prior to initiating treatment.

Identifying knowledge gaps in understanding the effects of selective serotonin reuptake inhibitors (SSRIs) on fish behaviour

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants increasingly prescribed to treat patients with clinical depression. As a result of the significant negative impact of the COVID-19 pandemic on the population's mental health, its consumption is expected to increase even more. The high consumption of these substances leads to their environmental dissemination, with evidence of their ability to compromise molecular, biochemical, physiological, and behavioural endpoints in non-target organisms. This study aimed to provide a critical review of the current knowledge regarding the effects of SSRI antidepressants on fish ecologically relevant behaviours and personality-dependent traits. A literature review shows limited data concerning the impact of fish personality on their responses to contaminants and how such responses could be influenced by SSRIs. This lack of information may be attributable to a lack of widely adopted standardized protocols for evaluating behavioural responses in fish. The existing studies examining the effects of SSRIs across various biological levels overlook the intra-specific variations in behaviour and physiology associated with different personality patterns or coping styles. Consequently, some effects may remain undetected, such as variations in coping styles and the capacity to handle environmental stressors. This oversight could potentially result in long-term effects with ecological implications. Data support the need for more studies to understand the impact of SSRIs on personality-dependent traits and how they may impair fitness-related behaviours. Given the considerable cross-species similarity in the personality dimensions, the collected data may allow new insights into the correlation between personality and animal fitness.

Determination of the Effect of Wastewater on the Biological Activity of Mixtures of Fluoxetine and Its Metabolite Norfluoxetine with Nalidixic and Caffeic Acids with Use of E. coli Microbial Bioindicator Strains

In the present work, the conducted research concerned the determination of the toxicity and oxidative stress generation of the antidepressant fluoxetine (FLU), its metabolite nor-fluoxetine (Nor-FLU), the antibiotic nalidixic acid (NA), caffeic acid (CA) and their mixtures in three different environments: microbial medium (MM), raw wastewaters (RW) and treated wastewaters (TW). We evaluated the following parameters: E. coli cell viability, toxicity and protein damage, sodA promoter induction and ROS generation. It was found that FLU, Nor-FLU, NA, CA and their mixtures are toxic and they have the potency to generate oxidative stress in E. coli strains. We also detected that the wastewater, in comparison to the microbial medium, had an influence on the toxic activity and oxidative stress synthesis of the tested chemicals and their mixtures. Regardless of the environment under study, the strongest toxic activity and oxidative stress generation were detected after bacterial incubation with NA at a concentration of 1 mg/dm³ and the mixture of FLU (1 mg/dm³) with Nor-FLU (0.1 mg/dm³) and with NA (0.1 mg/dm³). The ROS synthesis and sodA promoter induction suggest that, in the case of the examined compounds and their mixtures, oxidative stress is the mechanism of toxicity. The analysis of the types of interactions among the substances constituting the mixtures in the wastewater revealed synergism, potentiation and antagonism.

Antidepressant pharmaceuticals in aquatic systems, individual-level ecotoxicological effects: growth, survival and behavior

The growing consumption of antidepressant pharmaceuticals has resulted in their widespread occurrence in the environment, particularly in waterways with a typical concentration range from ng L^-1 to μg L^-1. An increasing number of studies have confirmed the ecotoxic potency of antidepressants, not only at high concentrations but also at environmentally relevant levels. The present review covers literature from the last decade on the individual-level ecotoxicological effects of the most commonly used antidepressants, including their impact on behavior, growth, and survival. We focus on the relationship between antidepressants physico-chemical properties and dynamics in the environment. Furthermore, we discuss the advantages of considering behavioral changes as sensitive endpoints in ecotoxicology, as well as some current methodological shortcomings in the field, including low standardization, reproducibility and context-dependency.

Serotonin Syndrome: The Role of Pharmacology in Understanding Its Occurrence

Serotonin syndrome (SS) is a potentially fatal adverse drug reaction characterized by an exaggerated increase in serotonergic activity in the central and peripheral nervous systems. It presents a constellation of signs and symptoms related to behavioral changes, neuromuscular excitability, and autonomic instability. These symptoms can occur in both mild and severe forms. SS can be triggered by the therapeutic use of a drug that increases serotonin (5-HT) availability in the synaptic cleft or by the co-administration of two or more drugs that provide this increase. With the escalating use of antidepressants by the world's population, this adverse reaction may be more recurrent. However, SS is often overlooked by patients or not diagnosed by doctors. This review aims to improve awareness about SS and provide a pharmacological perspective to explain its occurrence. Evidence shows that other neurotransmitters may also be involved with the pathology of SS. Furthermore, SS and neuroleptic malignant syndrome (NMS) seem to be part of the same pathological spectrum, especially in atypical NMS cases. The emergence of the syndrome's symptoms may be closely related to pharmacokinetic and/or pharmacodynamic polymorphisms that lead to an increase in the 5-HT available to or 5-HT signaling by specific receptors, thus constituting an important area for future investigations.

Reports analysis of psychotropic drugs related adverse reactions in Australia and Poland during the COVID 19 pandemic

BACKGROUND

The COVID-19 pandemic has caused significant changes to the global health care system AIMS: It is unknown whether the COVID-19 pandemic influenced the occurrence of adverse drug reactions (ADR) of antidepressive agents, benzodiazepines, and antipsychotics plus mood stabilizers (AaMS). The study was designed in order to compare the incidence of ADR during the COVID-19 pandemic with the period preceding the pandemic in Poland and Australia, different in terms of their COVID-19 prevention strategy.

METHOD

We analysed ADR from the three surveyed pharmacological groups of drugs observed in Poland and Australia in the period prior to, and during the COVID-19 pandemic RESULTS: In Poland, a noticeable increase in the reported ADR of the assessed drug groups was observed during the COVID-19 pandemic. The highest was for antidepressive agents, but the reporting of ADR for benzodiazepines and AaMS drugs also increased significantly. In the case of ADR in Australian patients, the increase in the number of reported ADR for antidepressive agents was modest compared to that seen in Poland, but still noticeable, and there was a significant increase in ADR for benzodiazepines CONCLUSIONS: This study showed that the COVID-19 pandemic has had an impact on the incidence of ADR reported among both Polish and Australian patients but the modality of this was different.

The metabolites could not be ignored: A comparative study of the metabolite norfluoxetine with its parent fluoxetine on zebrafish (Danio rerio)

The ubiquitous pharmaceuticals in aquatic environments have attracted huge attention due to their significant risks to humans and ecosystems. However, even though the knowledge of the negative effects induced by the parent pharmaceuticals is quite extensive, little is known about their metabolites for a long time. This study provides systematical knowledge about the potential toxicity of metabolite norfluoxetine and its parent fluoxetine on zebrafish (Danio rerio) at the early life stage. The results showed that the metabolite norfluoxetine had similar acute toxicity in fish with the parent fluoxetine. For the altered fish development, there was no significant difference in most cases between the two pharmaceuticals. Compared to the control, the metabolite markedly inhibited the locomotor behavior under light-to-dark transitions, which was comparable to the parent. Norfluoxetine could easily accumulate but hardly eliminate from fish, relative to fluoxetine. In addition, the accumulated fluoxetine in zebrafish may rapidly metabolize to norfluoxetine and then be eliminated through different metabolic pathways. The functional genes related to serotonergic process (5-ht1aa, 5-ht2c, slc6a4b, and vmat), early growth (egr4), and circadian rhythm (per2) were downregulated by both the norfluoxetine and fluoxetine, indicative of the same mode-of-action of norfluoxetine with its parent in these functions. Meanwhile, the alterations caused by norfluoxetine were more pronounced than that of fluoxetine in the genes of 5-ht2c, slc6a4b, vmat, and per2. The molecular docking also confirmed that norfluoxetine could bind with serotonin transporter protein in the same as fluoxetine with a lower binding free energy. Overall, the metabolite norfluoxetine could induce similar and even more toxic effects on zebrafish with the same mode of action. The different and binding energy of the metabolite norfluoxetine and its parent fluoxetine on zebrafish may be responsible for the differentiated effects. It highlights the risks of the metabolite norfluoxetine in the aquatic environment could not be ignored.

Formation of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) in the electrochemical oxidation of polluted waters with pharmaceuticals used against COVID-19

The COVID-19 pandemic has produced a huge impact on our lives, increasing the consumption of certain pharmaceuticals, and with this, contributing to the intensification of their presence in wastewater and in the environment. This situation demands the implementation of efficient remediation technologies, among them, electrochemical oxidation (ELOX) is one the most applied. This work studies the application of ELOX with the aim of eliminate pharmaceuticals used in the fight against COVID-19, assessing its degradation rate, as well as the risk of formation of toxic trace by-products, such as unintentional POPs like polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). To this end, model solutions containing 10 mg L^-1 of dexamethasone (DEX), paracetamol (PAR), amoxicillin (AMX), and sertraline (STR) with two different electrolytes (NaCl and Na₂SO₄) have been evaluated. However, electrochemical systems that contain chloride ions in solution together with PCDD/Fs precursor molecules may lead to the formation of these highly toxic by-products. So, PCDD/Fs were quantified under conditions of complete degradation of the drugs. Furthermore, the presence of PCDD/Fs precursors such as chlorophenols was determined, as well as the role of Cl^-, Cl^• and SO 4 • - radicals in the formation of the by-products and PCDD/Fs. The maximum measured concentration of PCDD/Fs was around 2700 pg L^-1 for the amoxicillin case in NaCl medium. The obtained results emphasise the importance of not underestimating the potential formation of these highly toxic trace by-products, in addition to the correct selection of oxidation processes and operation variables, in order to avoid final higher toxicity in the medium.

Psychotropic consumption before and during COVID-19 in Asturias, Spain

BACKGROUND

Spain as multiple other countries has been experiencing an increasing and sustained trend in the use of psychotropic medications since the mid 90s. Recent studies show public health measures implemented to control SARS-Cov2, such as mobility restrictions and the shutdown of nonessential activities increased mental suffering, even contributing to a higher number of anxiety, depression and insomnia disorders that could lead to an increase in the consumption of psychotropics. The aims were: 1) Evaluate the temporal trend in psychotropic consumption by pharmacological subgroup, sex, and age group 2) Estimate the effect of the COVID-19 pandemic in the use of psychotropic drugs.

METHODS

We conducted a retrospective observational study, retrieving all prescriptions of anxiolytics, hypnotics and sedatives, and antidepressants dispensed in pharmacies of Asturias (Northern Spain) for Primary Care patients for the period 2018-2021. We presented the data expressed in Daily Defined Doses (DDDs) for 1000 persons/day (DHD). To estimate changes in DHDs by year and age group we conducted two multiple linear regressions (one for males and one for females) for every pharmacological subgroup studied. Changes were considered statistically significant when the regression coefficient was p < 0.05. We used the Software R 4.1.0.

RESULTS

For the studied period, the highest DHDs are for antidepressants, although all of the subgroups experienced an increase in consumption rates. Women consumed more psychotropic drugs than men. In 2021, 372 out of every 1000 women were taking daily 1 DDD of these drugs versus 184 out of every 1000 men. Consumption rates for all psychotropic drugs progressively increases with age. Conversely, the biggest increases in consumption were among the youngest age groups (0-14 and 15-29 years) for women, while for men there is more variability. The regression models suggest an upward trend in psychotropic consumption during all the period, especially remarkable from 2020, for both genders and all age groups.

CONCLUSIONS

- The consumption of psychotropic drugs has gradually increased over the last 4 years, with a significant boost starting in 2020 for both sexes, matching the start of the SARS-COV2 pandemic and the implementation of strict Public Health measures to contain it. - The increase observed on children and adolescents is a matter of concern.

Distribution, Bioaccumulation, and Risks of Pharmaceutical Metabolites and Their Parents: A Case Study in an Yunliang River, Nanjing City

The occurrence, bioaccumulation, and risks of 11 pairs of pharmaceutical metabolites and their respective parents were investigated in the water, sediment, and fish of an urban river in Nanjing city, China. The results showed that most of the target metabolites and their parents were detected in all water samples, with concentrations ranging from 0.1 ng/L to 72.9 ng/L. In some cases, the concentrations of metabolites in water were significantly higher than their parents, with fold changes reaching up 4.1 in the wet season and 6.6 in the dry season, while in sediment and fish, a lower concentration was observed in most cases. A lowered concentration of detected pharmaceuticals was observed in the dry season when compared to the wet season due to the seasonal variation in pharmaceutical consumption and overflow effluent. The bioaccumulation of pharmaceuticals in different fish tissues were detected with a descending order of overall concentration as gill > brain > muscle > gonad > intestine > liver > blood. In addition, the concentrations of both metabolites and their parents also decreased along the river in two seasons. However, the concentration rates of metabolites and their parents were significantly altered along the river in both water and sediment. The relatively high concentration proportions of the detected pharmaceuticals in water suggested that pharmaceuticals were more likely to apportion in water than in sediment, especially for the metabolites. Meanwhile, the rates of the metabolite/parent pairs between fish and water/sediment were generally lower, indicating the higher excretion capacity of metabolites from fish than their parents. Most of the detected pharmaceuticals had no impact on aquatic organisms. However, the presence of ibuprofen posed a medium risk to fish. Compared to the parents, metabolites showed a relatively low risk value but a high contribution to the total risk. It highlights that metabolites in the aquatic environments cannot be ignored.

Long and Short Duration Exposures to the Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine, Paroxetine and Sertraline at Environmentally Relevant Concentrations Lead to Adverse Effects on Zebrafish Behaviour and Reproduction

Selective serotonin reuptake inhibitors (SSRIs) are currently the most prescribed class of psychotropic medications. Their increased global manufacture and use have become growing concerns for aquatic toxicologists and environmental biologists, who assess both the direct and indirect effects of substances on the environment and on human health. In order to assess the potential impact of environmentally relevant levels of SSRIs on fish development, behaviour and reproduction, we exposed juvenile and adult zebrafish to a select group of SSRIs using two separate exposure paradigms. In the first paradigm, juvenile zebrafish were exposed to Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft) or a mixture of the three beginning at environmentally relevant levels (10 µg/L) for 135 days (long-term exposure) beginning at 5 days post fertilization (dpf). In the second paradigm, adult zebrafish were exposed to matching concentrations of the same SSRIs for 35 days (short-term exposure). The long-term exposure paradigm proved to have little to no overt effect on growth or development at sub-lethal concentrations (10 and 100 µg/L). However, both the stress/anxiety response (novel tank tests) and reproduction (fecundity and fertility) were dramatically reduced. Importantly, the short-term exposure of reproductively mature fish led to similar adverse effects on both the stress response and reproduction. Following both the short and long duration exposure paradigms, a 2-week washout period led to a small reduction in the adverse effects. These findings highlight the potential for SSRIs to negatively impact population dynamics in zebrafish and may be of particular value should they be found in other fish species in the environment.

Potentiometric Determination of Maprotiline Hydrochloride in Pharmaceutical and Biological Matrices Using a Novel Modified Carbon Paste Electrode

Potentiometry with membrane selective electrodes is preferable for measuring the various constituents of pharmaceuticals. In this work, carbon paste electrodes (CPE) were prepared, modified, and tested for the determination of maprotiline hydrochloride, which acts as an antidepressant. The proposed CPE was based on an ionic association complex of maprotiline-tetraphenylborate, 2-nitrophenyloctyl as a binder, and sodium tetraphenylborate as an ionic lipophilic additive. The optimized composition improved potentiometric properties up to theoretical Nernst response values of -59.5 ± 0.8 mV dec^-1, in the concentration range of maprotiline from 1.6 × 10^-7 to 1.0 × 10^-2 mol L^-1, and a detection limit of 1.1 × 10^-7 mol L^-1. The CPE provides excellent reversibility and reproducibility, exhibits a fast response time, and is applicable over a wide pH range. No significant effect was observed in several interfering species tested. The proposed electrode was used for the precise determination of maprotiline in pure solutions, urine samples, and a real sample-the drug Ludiomil.

Developmental exposure to sertraline impaired zebrafish behavioral and neurochemical profiles

The number of people suffering from mental health problems is rising, with anxiety and depression now the most commonly diagnosed psychiatric conditions. Selective serotonin reuptake inhibitors (SSRIs) are one of the most prescribed pharmaceuticals to treat these conditions, which has led to their common detection in many aquatic ecosystems. As the monoaminergic system shows a high degree of structural conservation across diverse animal phyla, a reasonable assumption is that the environmental levels of SSRIs in surface water can lead to adverse effects on fish and other aquatic wildlife. For instance, Sertraline (SER), a widely prescribed SSRI, has been shown to induce adverse effects in fish, albeit most of the reports used exposure concentrations exceeding those occurring in natural environments. Therefore, there is still a great lack of knowledge regarding SERs effects in fish species, especially during early life stages. This study describes the evaluation of developmental exposure of zebrafish (Danio rerio) to environmentally relevant concentrations of SER (from 0.01 to 10 μg/L), using a battery of key survival behaviors and further relating them with the expression of genes and neurochemical profiles of the monoaminergic system. We found that developmental exposure to SER did not affect embryo morphogenesis and growth. However, concentrations as low as 0.1 μg/L induced hypolocomotion and delayed learning. The observed behavioral impairment was associated with augmented serotonin levels rather than other neurochemicals and molecular markers, highlighting the relationship between serotonin signaling and behavior in zebrafish.

The Effects of Paroxetine on Benthic Microbial Food Web and Nitrogen Transformation in River Sediments

Paroxetine is a common pharmaceutical to treat depression and has been found to pose threats to aquatic organisms. However, little is known about the effects of paroxetine on the nutrient cycle in aquatic environments. Therefore, DNA metabarcoding is used in this study to analyze the effects of paroxetine on multi-trophic microorganisms and nitrogen transformation in river sediments. Although paroxetine has no significant effect on the diversity of microbenthos, changes in benthic nitrogen-converting bacteria are consistent with the change in the various forms of nitrogen in the sediment, indicating that paroxetine affects the nitrogen conversion process by affecting nitrogen-converting bacteria. In addition, it is found that paroxetine has the ability to influence nitrogen transformation in an indirect way by affecting the trophic transfer efficiency of higher trophic levels (meiofauna and protozoa, protozoa and protozoa), subsequently affecting the growth of nitrogen-converting bacteria through a top-down mechanism (i.e., predation).The results show that paroxetine affects nitrogen transformation directly by affecting nitrogen-converting bacteria and indirectly through top-down effects, emphasizing that the assessment of paroxetine's ecological risks should consider species within different trophic levels.

Identification of Photodegradation Products of Escitalopram in Surface Water by HPLC-MS/MS and Preliminary Characterization of Their Potential Impact on the Environment

The study concerns the photodegradation of the antidepressant escitalopram (ESC), the S-enantiomer of the citalopram raceme, both in ultrapure and surface water, considering the contribution of indirect photolysis through the presence of nitrate and bicarbonate. The effect of nitrate and bicarbonate concentrations was investigated by full factorial design, and only the nitrate concentration resulted in having a significant effect on the degradation. The kinetics of ESC photodegradation is the pseudo-first-order (half-life = 62.4 h in ultrapure water and 48.4 h in lake water). The generation of transformation products (TPs) was monitored through a developed and validated HPLC-MS/MS method. Fourteen TPs were identified in ultrapure water (one of them, at m/z 261, for the first time) and other two TPs at m/z 327 (found for the first time in this study) were identified only in presence of a nitrate. Several TPs were the same as those formed during the photodegradation of citalopram. The photodegradation pathway of ESC and its mechanism of degradation in water is proposed. The method was applied successfully to the analyses of surface water samples, in which a few dozen of ng L−1 of ESC was determined together with the presence of TP2, TP5 and TP12. Finally, a preliminary in silico evaluation of the toxicological profile and environmental behavior of TPs by computational models was carried out; two TPs (TP4 and TP10) were identified as of potential concern, as they were predicted mutagenic by Ames test model.