To examine the associations between urinary antibiotics from various sources and depression in the elderly using the biomonitoring method.
In the current study, we investigated 990 elderly individuals (≥ 60 years old) from a community-based elderly cohort in West Anhui, China. The participants were interviewed by the Geriatric Depression Scale and self-developed questionnaires. A total of 45 antibiotics belonging to nine categories were screened in urine samples by the developed liquid chromatography electrospray tandem mass spectrometry method. Creatinine-corrected concentrations of antibiotics in urines were used to assess their exposure. Logistic regression analysis was employed to test the relationships between exposure to antibiotics and depression.
Compared to the control group, the multinomial logistic regression analyses showed the elderly exposed to higher concentrations of azithromycin (OR = 1.81, 95% CI: 1.09–3.00) and sulfaclozine (OR = 1.54, 95% CI: 1.05–2.28) had increased risks of depression, respectively. After categorizing the detected antibiotics, tetracyclines (OR = 1.48, 95% CI: 1.02–2.16) and veterinary antibiotics (VAs) (OR = 1.53, 95% CI: 1.06–2.20) were positively correlated with increased risks of depression. After stratified by sex, the VAs (OR = 2.04, 95% CI: 1.13–3.71) at higher concentrations were associated with elevated risks of depression in males, while the associations between depression and antibiotic exposures were observed in tetracyclines (OR = 1.74, 95% CI: 1.04–2.85) and all antibiotics (OR = 2.24, 95% CI: 1.01–2.94) at higher levels in females, respectively. Notably, after the stratification by age, the significant associations were mainly present in the subjects under the age of 70.
Our findings reveal that azithromycin, sulfaclozine, tetracyclines, and the VAs were significantly associated with elevated risks of depression in the elderly. Importantly, sex- and age-specific differences were observed in the associations between antibiotic exposures and depression.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The datasets generated during and analyzed during the current study are not publicly available due to the privacy of the research group, but are available from the corresponding author on reasonable request.
Abrams E, Netchiporouk E, Miedzybrodzki B, Ben-Shoshan M (2019) Antibiotic allergy in children: more than just a label. Int Arch Allergy Immunol 180:103–112. https://doi.org/10.1159/000501518
Almeida AR, Tacão M, Machado AL, Golovko O, Zlabek V, Domingues I, Henriques I (2019) Long-term effects of oxytetracycline exposure in zebrafish: a multi-level perspective. Chemosphere 222:333–344. https://doi.org/10.1016/j.chemosphere.2019.01.147
An R, Wilms E, Masclee AAM, Smidt H, Zo Etendal EG, Jonkers D (2018) Age-dependent changes in GI physiology and microbiota: time to reconsider? Gut 67:2213–2222. https://doi.org/10.1136/gutjnl-2017-315542
Anonymous (1997) Medical Association declaration of Helsinki. Recommendations guiding physicians in biomedical research involving human subjects. JAMA Jama J Am Med Assoc 277:925–926. https://doi.org/10.1001/jama.1997.03540350075038
Becattini S, Taur Y, Pamer EG (2016) Antibiotic-induced changes in the intestinal microbiota and disease. Trends Mol Med 22:458–478. https://doi.org/10.1016/j.molmed.2016.04.003
Biagi E, Franceschi C, Rampelli S, Severgnini M, Ostan R, Turroni S, Consolandi C, Quercia S, Scurti M, Monti D, Capri M, Brigidi P, Candela M (2016) Gut microbiota and extreme longevity. Curr Biol 26:1480–1485. https://doi.org/10.1016/j.cub.2016.04.016
Bungau S, Tit DM, Behl T, Aleya L, Zaha DC (2021) Aspects of excessive antibiotic consumption and environmental influences correlated with the occurrence of resistance to antimicrobial agents. Curr Opin Environ Sci Health 19:100224. https://doi.org/10.1016/j.coesh.2020.10.012
Champagne-Jorgensen K, Mian MF, Kay S, Hanani H, Ziv O, McVey Neufeld KA, Koren O, Bienenstock J (2020) Prenatal low-dose penicillin results in long-term sex-specific changes to murine behaviour, immune regulation, and gut microbiota. Brain Behav Immun 84:154–163. https://doi.org/10.1016/j.bbi.2019.11.020
Chan AC (1996) Clinical validation of the Geriatric Depression Scale (GDS): Chinese version. J Aging Health 8:238–253. https://doi.org/10.1177/089826439600800205
Chatterjee A, Modarai M, Naylor NR, Boyd SE, Atun R, Barlow J, Holmes AH, Johnson A, Robotham JV (2018) Quantifying drivers of antibiotic resistance in humans: a systematic review. Lancet Infect Dis 18:e368–e378. https://doi.org/10.1016/s1473-3099(18)30296-2
Chen J, Ying GG, Deng WJ (2019) Antibiotic residues in food: extraction, analysis, and human health concerns. J Agric Food Chem 67(27):7569–7586. https://doi.org/10.1021/acs.jafc.9b01334
Claesson MJ, Cusack S, O’Sullivan O, Greene-Diniz R, de Weerd H, Flannery E, Marchesi JR, Falush D, Dinan T, Fitzgerald G, Stanton C, van Sinderen D, O’Connor M, Harnedy N, O’Connor K, Henry C, O’Mahony D, Fitzgerald AP, Shanahan F, Twomey C, Hill C, Ross RP, O’Toole PW (2011) Composition, variability, and temporal stability of the intestinal microbiota of the elderly. Proc Natl Acad Sci U S A 108(Suppl 1):4586–4591. https://doi.org/10.1073/pnas.1000097107
Cone LA, Padilla L, Potts BE (2003) Delirium in the elderly resulting from azithromycin therapy. Surg Neurol 59:509–511. https://doi.org/10.1016/s0090-3019(03)00065-x
Dinan TG, Cryan JF (2017) Gut instincts: microbiota as a key regulator of brain development, ageing and neurodegeneration. J Physiol 595:489–503. https://doi.org/10.1113/jp273106
Dinleyici M, Yildirim GK, Aydemir O, Kaya TB, Bildirici Y, Carman KB (2018) Human milk antibiotic residue levels and their relationship with delivery mode, maternal antibiotic use and maternal dietary habits. Eur Rev Med Pharmacol Sci 22(19):6560–6566. https://doi.org/10.26355/eurrev_201810_16072
Dong Y, Steins D, Sun S, Li F, Amor JD, James CJ, Xia Z, Dawes H, Izadi H, Cao Y, Wade DT (2018) Does feedback on daily activity level from a Smart watch during inpatient stroke rehabilitation increase physical activity levels? Study protocol for a randomized controlled trial. Trials 19:177. https://doi.org/10.1186/s13063-018-2476-z
Dutta SK, Verma S, Jain V, Surapaneni BK, Vinayek R, Phillips L, Nair PP (2019) Parkinson’s disease: the emerging role of gut dysbiosis, antibiotics, probiotics, and fecal microbiota transplantation. J Neurogastroenterol Motil 25:363–376. https://doi.org/10.5056/jnm19044
Feng L, Cheng Y, Zhang Y, Li Z, Yu Y, Feng L, Zhang S, Xu L (2020) Distribution and human health risk assessment of antibiotic residues in large-scale drinking water sources in Chongqing area of the Yangtze River. Environ Res 185:109386. https://doi.org/10.1016/j.envres.2020.109386
Firth A, Prathapan P (2020) Azithromycin: the first broad-spectrum therapeutic. Eur J Med Chem 207:112739. https://doi.org/10.1016/j.ejmech.2020.112739
Fraser GE, Welch A, Luben R, Bingham SA, Day NE (2000) The effect of age, sex, and education on food consumption of a middle-aged English cohort-EPIC in East. Anglia Prev Med 30:26–34. https://doi.org/10.1006/pmed.1999.0598
Gao H, Shu Q, Chen J, Fan K, Xu P, Zhou Q, Li C, Zheng H (2019) Antibiotic exposure has sex-dependent effects on the gut microbiota and metabolism of short-chain fatty acids and amino acids in mice. mSystems 4. https://doi.org/10.1128/mSystems.00048-19
Grigoryan L, Germanos G, Zoorob R, Juneja S, Raphael JL, Paasche-Orlow MK, Trautner BW (2019) Use of antibiotics without a prescription in the U.S. population: a scoping review. Ann Intern Med 171:257–263. https://doi.org/10.7326/m19-0505
Guida F, Turco F, Iannotta M, De Gregorio D, Palumbo I, Sarnelli G, Furiano A, Napolitano F, Boccella S, Luongo L, Mazzitelli M, Usiello A, De Filippis F, Iannotti FA, Piscitelli F, Ercolini D, de Novellis V, Di Marzo V, Cuomo R, Maione S (2018) Antibiotic-induced microbiota perturbation causes gut endocannabinoidome changes, hippocampal neuroglial reorganization and depression in mice. Brain Behav Immun 67:230–245. https://doi.org/10.1016/j.bbi.2017.09.001
Hao WZ, Li XJ, Zhang PW, Chen JX (2020) A review of antibiotics, depression, and the gut microbiome. Psychiatry Res 284:112691. https://doi.org/10.1016/j.psychres.2019.112691
Havers FP, Hicks LA, Chung JR, Gaglani M, Murthy K, Zimmerman RK, Jackson LA, Petrie JG, McLean HQ, Nowalk MP, Jackson ML, Monto AS, Belongia EA, Flannery B, Fry AM (2018) Outpatient antibiotic prescribing for acute respiratory infections during influenza seasons. JAMA Netw Open 1:e180243. https://doi.org/10.1001/jamanetworkopen.2018.0243
Hou X, Lu J, Weng J, Ji L, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, Yang Z, Yang W, Jia W (2013) Impact of waist circumference and body mass index on risk of cardiometabolic disorder and cardiovascular disease in Chinese adults: a national diabetes and metabolic disorders survey. PLoS One 8:e57319. https://doi.org/10.1371/journal.pone.0057319
Hou X, Zhu L, Zhang X, Zhang L, Bao H, Tang M, Wei R, Wang R (2019) Testosterone disruptor effect and gut microbiome perturbation in mice: early life exposure to doxycycline. Chemosphere 222:722–731. https://doi.org/10.1016/j.chemosphere.2019.01.101
Huang TT, Lai JB, Du YL, Xu Y, Ruan LM, Hu SH (2019) Current understanding of gut microbiota in mood disorders: an update of human studies. Front Genet 10:98. https://doi.org/10.3389/fgene.2019.00098
Ilgin S, Can OD, Atli O, Ucel UI, Sener E, Guven I (2015) Ciprofloxacin-induced neurotoxicity: evaluation of possible underlying mechanisms. Toxicol Mech Methods 25:374–381. https://doi.org/10.3109/15376516.2015.1026008
Jahansouz C, Staley C, Kizy S, Xu H, Hertzel AV, Coryell J, Singroy S, Hamilton M, DuRand M, Bernlohr DA, Sadowsky MJ, Khoruts A, Ikramuddin S (2019) Antibiotic-induced disruption of intestinal microbiota contributes to failure of vertical sleeve gastrectomy. Ann Surg 269:1092–1100. https://doi.org/10.1097/SLA.0000000000002729
Jašarević E, Morrison KE, Bale TL (2016) Sex differences in the gut microbiome-brain axis across the lifespan. Philos Trans R Soc Lond Ser B Biol Sci 371:20150122. https://doi.org/10.1098/rstb.2015.0122
Kang HS, Lee SB, Shin D, Jeong J, Hong JH, Rhee GS (2018) Occurrence of veterinary drug residues in farmed fishery products in South Korea. Food Control 85:57–65
Katzman R, Zhang MY, Ouang Ya Q, Wang ZY, Liu WT, Yu E, Wong SC, Salmon DP, Grant I (1988) A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey. J Clin Epidemiol 41:971–978. https://doi.org/10.1016/0895-4356(88)90034-0
Kaur K, Fayad R, Saxena A, Frizzell N, Chanda A, Das S, Chatterjee S, Hegde S, Baliga MS, Ponemone V, Rorro M, Greene J, Elraheb Y, Redd AJ, Bian J, Restaino J, Norris LB, Qureshi ZP, Love BL, Brookstaver B, Georgantopoulos P, Sartor O, Raisch DW, Rao G, Lu K, Ray P, Hrusheshky W, Schulz R, Ablin R, Noxon V, Bennett CL, Southern Network on Adverse Reactions Project (2016) Fluoroquinolone-related neuropsychiatric and mitochondrial toxicity: a collaborative investigation by scientists and members of a social network. J Commun Support Oncol 14:54–65. https://doi.org/10.12788/jcso.0167
Kiel A, Catalano A, Clark CM, Wattengel BA, Mason J, Sellick J, Mergenhagen KA (2020) Antibiotic prescribing in the emergency department versus primary care: implications for stewardship. J Am Pharm Assoc : JAPhA 60:789–795.e782. https://doi.org/10.1016/j.japh.2020.03.016
Kurjogi M, Issa Mohammad YH, Alghamdi S, Abdelrahman M, Satapute P, Jogaiah S (2019) Detection and determination of stability of the antibiotic residues in cow’s milk. PLoS One 14:e0223475. https://doi.org/10.1371/journal.pone.0223475
Leclercq S, Mian FM, Stanisz AM, Bindels LB, Cambier E, Ben-Amram H, Koren O, Forsythe P, Bienenstock J (2017) Low-dose penicillin in early life induces long-term changes in murine gut microbiota, brain cytokines and behavior. Nat Commun 8:15062. https://doi.org/10.1038/ncomms15062
Li Y-W, Wu X-L, Mo C-H, Tai Y-P, Huang X-P, Xiang L (2011) Investigation of sulfonamide, tetracycline, and quinolone antibiotics in vegetable farmland soil in the Pearl River Delta Area, Southern China. J Agric Food Chem 59:7268–7276. https://doi.org/10.1021/jf1047578
Li H, Jia J, Yang Z (2016) Mini-Mental State Examination in Elderly Chinese: A Population-Based Normative Study. J Alzheimers Dis 53:487–496. https://doi.org/10.3233/jad-160119
Li N, Ho KWK, Ying GG, Deng WJ (2017) Veterinary antibiotics in food, drinking water, and the urine of preschool children in Hong Kong. Environ Int 108:246–252. https://doi.org/10.1016/j.envint.2017.08.014
Li XD, Cao HJ, Xie SY, Li KC, Tao FB, Yang LS, Zhang JQ, Bao YS (2019) Adhering to a vegetarian diet may create a greater risk of depressive symptoms in the elderly male Chinese population. J Affect Disord 243:182–187. https://doi.org/10.1016/j.jad.2018.09.033
Liu JL, Wong MH (2013) Pharmaceuticals and personal care products (PPCPs): A review on environmental contamination in China. Environment International 59:208–224. https://doi.org/10.1016/j.envint.2013.06.012
Liu S, Zhao G, Zhao H, Zhai G, Chen J, Zhao H (2017) Antibiotics in a general population: Relations with gender, body mass index (BMI) and age and their human health risks. Sci Total Environ 599-600:298–304. https://doi.org/10.1016/j.scitotenv.2017.04.216
Liu W, Hassan Gillani A, Xu S, Chen C, Chang J, Yang C, Ji W, Jiang M, Zhao M, Fang Y (2020) Antibiotics (Macrolides and Lincosamides) Consumption trends and patterns in China’s Healthcare Institutes. Based on a 3 year procurement records, 2015-2017. Int J Environ Res Public Health 18:113. https://doi.org/10.3390/ijerph18010113
Lurie I, Yang YX, Haynes K, Mamtani R, Boursi B (2015) Antibiotic exposure and the risk for depression, anxiety, or psychosis: a nested case-control study. J Clin Psychiatry 76:1522–1528. https://doi.org/10.4088/JCP.15m09961
Muaz K, Riaz M, Akhtar S, Park S, Ismail A (2018) Antibiotic residues in chicken meat: global prevalence, threats, and decontamination strategies: a review. J Food Prot 81:619–627. https://doi.org/10.4315/0362-028x.jfp-17-086
Murphy JR, Paul S, Dunlop AL, Corwin EJ (2018) Maternal peripartum antibiotic exposure and the risk of postpartum depression. Res Nurs Health 41:369–377. https://doi.org/10.1002/nur.21881
Reese AT, Cho EH, Klitzman B, Nichols SP, Wisniewski NA, Villa MM, Durand HK, Jiang S, Midani FS, Nimmagadda SN, O’Connell TM, Wright JP, Deshusses MA, David LA (2018) Antibiotic-induced changes in the microbiota disrupt redox dynamics in the gut. Elife 7:e35987. https://doi.org/10.7554/eLife.35987
Schiff E, May K, Goldstein LH (2010) Neuropsychiatric manifestations associated with azithromycin in two brothers. Eur J Clin Pharmacol 66:1273–1275. https://doi.org/10.1007/s00228-010-0900-8
Schlomann BH, Wiles TJ, Wall ES, Guillemin K, Parthasarathy R (2019) Sublethal antibiotics collapse gut bacterial populations by enhancing aggregation and expulsion. Proc Natl Acad Sci U S A 116:21392–21400. https://doi.org/10.1073/pnas.1907567116
Schutzius G, Nguyen M, Navab-Daneshmand T (2019) Antibiotic resistance in fecal sludge and soil in Ho Chi Minh City, Vietnam. Environ Sci Pollut Res Int 26:34521–34530. https://doi.org/10.1007/s11356-019-06537-5
Sylvia KE, Jewell CP, Rendon NM, St John EA, Demas GE (2017) Sex-specific modulation of the gut microbiome and behavior in Siberian hamsters. Brain Behav Immun 60:51–62. https://doi.org/10.1016/j.bbi.2016.10.023
Tang J, Shi T, Wu X, Cao H, Li X, Hua R, Tang F, Yue Y (2015) The occurrence and distribution of antibiotics in Lake Chaohu, China: seasonal variation, potential source and risk assessment. Chemosphere 122:154–161. https://doi.org/10.1016/j.chemosphere.2014.11.032
Wang Q, Tian W (2018) Prevalence, awareness, and treatment of depressive symptoms among the middle-aged and elderly in China from 2008 to 2015. Int J Health Plann Manag 33:1060–1070. https://doi.org/10.1002/hpm.2581
Wang H, Wang N, Wang B, Fang H, Fu C, Tang C, Jiang F, Zhou Y, He G, Zhao Q, Chen Y, Jiang Q (2016) Antibiotics detected in urines and adipogenesis in school children. Environ Int 89-90:204–211. https://doi.org/10.1016/j.envint.2016.02.005
Wang H, Wang N, Qian J, Hu L, Huang P, Su M, Yu X, Fu C, Jiang F, Zhao Q, Zhou Y, Lin H, He G, Chen Y, Jiang Q (2017) Urinary antibiotics of pregnant women in Eastern China and cumulative health risk assessment. Environ Sci Technol 51:3518–3525. https://doi.org/10.1021/acs.est.6b06474
Wang H, Tang C, Yang J, Wang N, Jiang F, Xia Q, He G, Chen Y, Jiang Q (2018a) Predictors of urinary antibiotics in children of Shanghai and health risk assessment. Environ Int 121:507–514. https://doi.org/10.1016/j.envint.2018.09.032
Wang H, Yang J, Yu X, Zhao G, Zhao Q, Wang N, Jiang Y, Jiang F, He G, Chen Y, Zhou Z, Jiang Q (2018b) Exposure of adults to antibiotics in a shanghai suburban area and health risk assessment: a biomonitoring-based study. Environ Sci Technol 52:13942–13950. https://doi.org/10.1021/acs.est.8b03979
Wang S, Qu Y, Chang L, Pu Y, Zhang K, Hashimoto K (2020) Antibiotic-induced microbiome depletion is associated with resilience in mice after chronic social defeat stress. J Affect Disord 260:448–457. https://doi.org/10.1016/j.jad.2019.09.064
Wei R, Ge F, Huang S, Chen M, Wang R (2011) Occurrence of veterinary antibiotics in animal wastewater and surface water around farms in Jiangsu Province, China. Chemosphere 82:1408–1414. https://doi.org/10.1016/j.chemosphere.2010.11.067
Wei S, Mortensen MS, Stokholm J, Brejnrod AD, Thorsen J, Rasmussen MA, Trivedi U, Bisgaard H, Sørensen SJ (2018) Short- and long-term impacts of azithromycin treatment on the gut microbiota in children: a double-blind, randomized, placebo-controlled trial. EBi oMedicine 38:265–272. https://doi.org/10.1016/j.ebiom.2018.11.035
Yang Z, Li J, Gui X, Shi X, Bao Z, Han H, Li MD (2020) Updated review of research on the gut microbiota and their relation to depression in animals and human beings. Mol Psychiatry 25:2759–2772. https://doi.org/10.1038/s41380-020-0729-1
Yatsunenko T, Rey FE, Manary MJ, Trehan I, Dominguez-Bello MG, Contreras M, Magris M, Hidalgo G, Baldassano RN, Anokhin AP, Heath AC, Warner B, Reeder J, Kuczynski J, Caporaso JG, Lozupone CA, Lauber C, Clemente JC, Knights D, Knight R, Gordon JI (2012) Human gut microbiome viewed across age and geography. Nature 486:222–227. https://doi.org/10.1038/nature11053
Zaha DC, Bungau S, Aleya S, Tit DM, Vesa CM, Popa AR, Pantis C, Maghiar OA, Bratu OG, Furau C, Moleriu RD, Petre I, Aleya L (2019) What antibiotics for what pathogens? The sensitivity spectrum of isolated strains in an intensive care unit. Sci Total Environ 687:118–127. https://doi.org/10.1016/j.scitotenv.2019.06.076
Zaha DC, Bungau S, Uivarosan D, Tit DM, Maghiar TA, Maghiar O, Pantis C, Fratila O, Rus M, Vesa CM (2020) Antibiotic consumption and microbiological epidemiology in surgery departments: results from a single study center. Antibiotics (Basel) 9(2):81. https://doi.org/10.3390/antibiotics9020081
Zhang QQ, Ying GG, Pan CG, Liu YS, Zhao JL (2015) Comprehensive evaluation of antibiotics emission and fate in the river basins of China: source analysis, multimedia modeling, and linkage to bacterial resistance. Environ Sci Technol 49:6772–6782. https://doi.org/10.1021/acs.est.5b00729
Zhang Q, Zhang D, Liu KY, Liu YH, Sheng J, Jin ZX, Wang SF, Bo QL, Wang JJ, Yin HF (2017) Perinatal sulfamonomethoxine exposure influences physiological and behavioral responses and the brain mTOR pathway in mouse offspring. Hum Exp Toxicol 36:256–275. https://doi.org/10.1177/0960327116646839
Zhang J, Liu X, Zhu Y, Yang L, Sun L, Wei R, Chen G, Wang Q, Sheng J, Liu A, Tao F, Liu K (2020) Antibiotic exposure across three generations from Chinese families and cumulative health risk. Ecotoxicol Environ Saf 191:110237. https://doi.org/10.1016/j.ecoenv.2020.110237
Zhu Y, Liu K, Zhang J, Liu X, Yang L, Wei R, Wang S, Zhang D, Xie S, Tao F (2020) Antibiotic body burden of elderly Chinese population and health risk assessment: a human biomonitoring-based study. Environ Pollut 256:113311. https://doi.org/10.1016/j.envpol.2019.113311
We thank all the staff and students who made contributions to the cohort study. We thank all the study participants for their support. We are deeply grateful for the help provided by all the members (Guanjun Chen, Sheng Wang and Shulong Li) in the Center for Scientific Research of Anhui Medical University. This work was supported by the National Natural Science Foundation of China (82073558), the Key Projects of Natural Science Research in Colleges and Universities of Anhui province (KJ2018A0164), and the Major Projects on College Leading Talent Team Introduced of Anhui (0303011224). We are deeply grateful for the help provided by all the members in the experimental center platform for physical and chemical of Anhui Medical University.
This study was funded by the National Natural Science Foundation of China (82073558), the Key Projects of Natural Science Research in Colleges and Universities of Anhui province (KJ2018A0164), and Major Projects on College Leading Talent Team Introduced of Anhui (0303011224).
Ethics approval and consent to participate
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Anhui Medical University (No. 20170284). Informed consent was obtained from all individual participants included in the study.
Consent for publication
Patients signed informed consent regarding publishing their data and photographs
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Responsible Editor: Lotfi Aleya
About this article
Cite this article
Liu, X., Zhang, J., Sang, Y. et al. Antibiotic exposure and potential risk of depression in the Chinese elderly: a biomonitoring-based population study. Environ Sci Pollut Res (2021). https://doi.org/10.1007/s11356-021-12560-2