‘Prescribing’ psychotropic medication to our rivers and estuaries

Abstract

SummaryThe influence of pharmaceuticals on the environment is an increasing concern among environmental toxicologists. It is known that their growing use is leading to detectable levels in wastewater, conceivably causing harm to aquatic ecosystems. Psychotropic medication is one such group of substances, particularly affecting high-income countries. While these drugs have a clear place in therapy, there is debate around the risk/benefit ratio in patients with mild mental health problems. Therefore, it is necessary to evaluate the wider implications as risks could extend beyond the individual to non-target organisms, particularly those in rivers and estuaries.Declaration of interestNone.

If not now, when?

“…3 Tomlin's editorial 4 draws attention to healthcare's contribution to poisonous greenhouse emissions and a previous article in this journal described the damage that excreted SSRI medications could be wreaking on our marine environment. 5 We are currently working towards a special edition of the BJPsych Bulletin on the climate crisis and psychiatry, which will highlight the problems and point to some solutions. In this vein, I am hopeful that many of the new ways we are working – telepsychiatry 6 and stripped-back bureaucracy – will outlive the current crisis.…”

Farmaco-Contaminación

“…Iatrogenias floridas que en el caso de los que maneja uno habitualmente abarcan desde la boca seca al síndrome neuroléptico maligno, pasando por el estreñimiento (a veces muy grave), las alteraciones genitourinarias, la ganancia de peso, las discrasias, la afectación de la libido o la discinesia tardía. Y esta es la reflexión que nos ofrece Ford y Herrera y que ocupara una parte importante de nuestra colaboración (1).…”

Predicting Hepatic Clearance of Psychotropic Drugs in Isolated Perfused Fish Livers Using a Combination of Two In Vitro Assays

“…Psychotropic pharmaceuticals are increasingly prescribed in Canada and globally to manage psychotic disorders, depression, epilepsy, and other conditions. , After active ingredients and their transformation products of these drugs are excreted, they reach municipal wastewater treatment plants, which only achieve incomplete removal of these compounds . Consequently, psychotropic drugs have been found in surface waters in the ng L –1 range and raise concerns over their potential uptake and toxicological effects on exposed aquatic organisms . In this proof-of-concept study, clearances of a group of selected IOCs were measured in isolated livers of rainbow trout (Oncorhynchus mykiss).…”

“…22 Consequently, psychotropic drugs have been found in surface waters in the ng L −1 range and raise concerns over their potential uptake and toxicological effects on exposed aquatic organisms. 23 In this proof-of-concept study, clearances of a group of selected IOCs were measured in isolated livers of rainbow trout (Oncorhynchus mykiss). Specifically nine psychotropic drugs were selected to represent important pharmaceutical classes, including antipsychotics (clozapine), antidepressants (amitriptyline, fluoxetine, venlafaxine, duloxetine, citalopram, and bupropion), and anticonvulsants (lamotrigine and carbamazepine).…”