Sertraline, a commonly used first-line antidepressant for major depressive disorder, is primarily metabolized by the polymorphic cytochrome P450 enzymes CYP2C19 and CYP2B6. This large-scale Chinese cohort study (N = 1070 patients; 1414 serum concentration measurements) evaluated whether incorporating CYP2B6 phenotype provides additional information beyond CYP2C19 phenotype in explaining interindividual variability in dose-normalized sertraline concentrations, and investigated associations between combined CYP2C19/CYP2B6 phenotypes and antidepressant switching within 1 year after the last therapeutic drug monitoring assessment. Patients were classified according to CYP2C19 and CYP2B6 metabolizer phenotypes as poor metabolizers (PMs), intermediate metabolizers (IMs), normal metabolizers (NMs), or rapid metabolizers (RMs), resulting in 16 combined phenotype groups, with CYP2C19 NM/CYP2B6 NM as the reference group. Eight phenotype groups had significantly higher model-estimated dose-normalized sertraline concentrations than the reference group. The largest observed fold difference was for CYP2C19 PM/CYP2B6 IMs (fold change, 2.11; 95% CI, 1.84-2.42; FDR-adjusted P < 0.001), whereas the smallest significant fold difference was observed for CYP2C19 NM/CYP2B6 IMs (fold change, 1.15; 95% CI, 1.06-1.26; FDR-adjusted P = 0.002). The combined CYP2C19/CYP2B6 model showed better fit than the CYP2C19-only model (likelihood ratio test χ[2] = 28.6, df = 3, P < 0.001). The overall incidence of antidepressant switching was 19.9%. Switching was more frequent in CYP2C19 PM/CYP2B6 IMs (34.3%; OR, 3.33; 95% CI, 1.50-7.41; P = 0.003), CYP2C19 IM/CYP2B6 IMs (26.2%; OR, 2.32; 95% CI, 1.33-4.06; P = 0.003), and CYP2C19 NM/CYP2B6 IMs (25.0%; OR, 2.26; 95% CI, 1.26-4.03; P = 0.006). These findings indicate that incorporating CYP2B6 phenotype provides additional information beyond CYP2C19 phenotype for characterizing variability in dose-normalized sertraline concentrations and support prospective evaluation of combined pharmacogenetic approaches to sertraline dosing and therapeutic drug monitoring.

ObjectiveTo evaluate the effects of Jue tone music therapy on depressive symptoms, sleep quality, activities of daily living, and selected serum biomarkers in patients with post-stroke depression (PSD).MethodsIn this randomized controlled trial, patients with PSD were randomly assigned to a control group or an intervention group. The control group received usual care, including sertraline hydrochloride and comprehensive rehabilitation training. The intervention group received additional Jue tone music therapy based on Five Element Music Therapy for 6 weeks. Depressive symptoms were assessed using the 24-item Hamilton Depression Scale (HAMD-24) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). Sleep quality and activities of daily living were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Barthel Index (BI). Serum interleukin-6 (IL-6), brain-derived neurotrophic factor (BDNF), and 5-hydroxytryptamine (5-HT) levels were measured before and after the intervention.ResultsA total of 91 patients completed the study (control group, n = 46; intervention group, n = 45). After 6 weeks, the intervention group showed significantly lower HAMD-24, HADS-D, and PSQI scores and higher BI scores compared with the control group (all P < 0.01). Serum IL-6 levels were significantly reduced, while BDNF and 5-HT levels were significantly increased in the intervention group (all P < 0.05). No significant differences in adverse events were observed between groups.ConclusionJue tone music therapy is a safe and effective adjunct to usual care, improving depressive symptoms, sleep quality, and functional outcomes in patients with PSD.

Beta-adrenoreceptor blockers (beta-blockers) and selective serotonin reuptake inhibitors (SSRIs) are commonly used medications and often used together, such as for the treatment of anxiety. However, there is no recent review of any potential adverse events related to concomitant use of medicines from each group. This scoping review therefore aimed to provide this narrative synthesis. Key databases were searched for articles published in English from 1 January 1990 to 24 November 2025 reporting any adverse event due to the concomitant use of beta-blockers and SSRIs in people aged 18 or over. Any study design was permitted. From 2211 distinct records, 117 articles were eligible for full-text screening, and 48 articles were included. Eight of these were review articles referring to otherwise-included empirical studies. Most were interventional (n = 19, 36.9%) or case reports (n = 14, 29.2%). Bradycardia was the most frequently reported adverse event (n = 11) mostly in case reports involving metoprolol-fluoxetine, metoprolol-paroxetine, metoprolol-sertraline or propranolol-fluoxetine. Blood pressure changes (including hypotension) were observed in half of studies which explored them. Neurocognitive-related symptoms were heterogeneous and there were four case reports/series of self-poisoning suicide or self-harm. The adverse events discussed in this review could be signals for drug-drug interactions. Where mechanism was postulated, authors mostly proposed pharmacokinetically mediated effects via Cytochrome P450 2D6. Signals described in this review of potential adverse events should be examined in robust observational studies of specific beta-blocker-SSRI combinations. This will enable precise estimation of the magnitude of any associated risks and provide insight into the potential mechanism.

Antidepressants are among the most widely prescribed pharmaceuticals worldwide, and compounds such as sertraline and citalopram have been detected in surface waters, raising concerns about their impacts on non-target aquatic organisms. The current study aimed to (i) evaluate immediate behavioral responses to citalopram and sertraline using habitat selection (avoidance and colonization) in zebrafish (Danio rerio) under non-forced exposure, and (ii) integrate these responses with short-term biochemical and behavioral alterations after forced exposure. Concentrations tested were 0.05, 0.2, 1, and 15 µg/L for citalopram and 0.05, 0.1, 0.5, and 2 µg/L for sertraline. In non-forced exposure, fish underwent individual avoidance/colonization tests (5 min) and a population avoidance test (3 h); In forced exposure, fish were exposed for 48 h to each concentration to assess behavioral and biochemical biomarkers. Under non-forced exposure, the zebrafish population avoided all tested concentrations, preferring the least contaminated compartments (p < 0.05). Forced exposure induced predatory inhibition (citalopram: 0.05 and 1 µg/L; sertraline: 0.5-2 µg/L; p < 0.05), hypolocomotion (citalopram: 0.2-1 µg/L; sertraline: 0.5 µg/L; p < 0.05), and anxiety-like responses (citalopram: 15 µg/L; sertraline: 2 µg/L; p < 0.05); only sertraline increased aggressive behavior (0.1-2 µg/L, p < 0.01). Both antidepressants significantly increased antioxidant defenses, with Glutathione S-transferase and Catalase the most sensitive biomarkers, responding from 0.05 µg/L (citalopram) and 0.1 µg/L (sertraline), depending on tissue (p < 0.05). Acetylcholinesterase activity was altered at similar concentrations (p < 0.05). Integrating non-forced habitat selection with forced-exposure biomarkers revealed both contaminant avoidance and latent toxicity not be captured by conventional single-compartment assays.

Pharmaceuticals are widely detected in surface waters, posing significant ecological and human-health risks. China is a major producer and consumer of pharmaceuticals, and widespread contamination has been reported in its surface waters. Regional differences in topography, hydrology, land use, and socioeconomic conditions can shape patterns of pharmaceutical exposure and risk, calling for priority lists tailored to individual river basins. However, previous studies mainly focused on national-scale assessments, selected river basins, or specific pharmaceutical classes. In this study, we systematically reviewed 226 peer-reviewed articles and compiled 8628 occurrence records for 158 pharmaceutical compounds. A multi-criteria prioritization framework that integrated both hazard and exposure potential was used to identify priority pharmaceuticals across nine river basins. Antibiotics were the most frequently detected class of pharmaceuticals, although most had low or moderate priority scores. Erythromycin, roxithromycin, and azithromycin were notable exceptions and ranked highly. Among nonantibiotic pharmaceuticals, estrone and ibuprofen ranked highly in all nine basins. Beyond these shared priorities, several pharmaceuticals showed distinct basin-specific priority pattern. Psychotropic medicines, including diazepam, fluoxetine, sertraline, and citalopram, were identified as priorities in highly urbanized basins, particularly the Haihe and Yangtze River basins. In the Yellow River Basin, the lipid modulator gemfibrozil was prioritized, while in the Pearl River Basin, the veterinary antibiotic salinomycin was prioritized. Combining the rankings with uncertainty estimates showed that high-priority compounds with low uncertainty should be considered for stringent monitoring and control, whereas compounds with high uncertainty require additional occurrence and toxicity data. These findings underscore the importance of basin-scale prioritization in capturing regional differences and provide a basis for tiered monitoring and management in China.

Background Pharmacological therapy, particularly the use of selective serotonin reuptake inhibitors (SSRIs), plays a central role in managing anxiety spectrum disorders. However, real-world clinical practice can deviate from evidence-based recommendations, leading to challenges such as prolonged benzodiazepine use, polypharmacy, and low rates of generic prescribing. Evaluating these real-world prescribing patterns, alongside patient adherence and adverse drug reactions (ADRs), is crucial for optimizing treatment. This study aimed to describe the prescribing patterns of anti-anxiety medications in a tertiary-care psychiatry outpatient department and to evaluate patient adherence and the incidence of ADRs. Methodology A cross-sectional observational study was conducted over six months, enrolling 150 consecutive adult patients (aged 18 to 60 years) diagnosed with anxiety or related disorders based on the International Classification of Diseases, 10th Revision (ICD-10) criteria. Sociodemographic details, clinical diagnoses, and complete prescription data were recorded. Medications were categorized by drug class, with polytherapy defined as the concurrent use of two or more anxiolytic agents. Medication adherence was assessed using the 10-item Medication Adherence Rating Scale (MARS-10). ADRs were documented through targeted patient interviews based on a symptom checklist. Results The study cohort had a mean age of 37.6±11.2 years and was predominantly made up of women (62%). Generalized anxiety disorder was the most frequent primary diagnosis (30%), followed by panic disorder (14.7%) and obsessive-compulsive disorder (13.3%). Selective serotonin reuptake inhibitors (SSRIs) were the most widely prescribed medication class, utilized in 73.3% of patients, with sertraline (22.7%) and escitalopram (22.7%) being the preferred agents. Benzodiazepines were prescribed to 44.7% of the cohort. Polytherapy was highly prevalent, occurring in 70% of cases, whereas generic prescribing was observed in only 8% of prescriptions. Patients demonstrated high medication adherence, with a mean MARS-10 score of 8.1±1.7 (68.7% classified as highly adherent). ADRs were reported by 19.3% of patients, most commonly presenting as gastritis (7.3%) and insomnia or restlessness (4.7%). No severe ADRs were noted, and there were no significant subgroup differences in adherence or ADR incidence between SSRI and benzodiazepine users versus non-users (P>0.05). Conclusions The predominant use of SSRIs in this setting aligns with standard pharmacological management for anxiety disorders. However, the high prevalence of anxiolytic polytherapy, substantial concurrent use of benzodiazepines, and an overwhelming preference for brand-name prescriptions highlight critical areas for clinical optimization. While medication adherence is robust and medications are generally well-tolerated, prioritizing rational monotherapy, implementing planned benzodiazepine tapering, and encouraging generic prescribing could further enhance the cost-effectiveness and safety of psychiatric care.