Pollution and antidepressants: The flavour of medications in our tasteless waters
By: Daniela Enache
Tags: Antidepressants, Environment, Clean Water, Pollution, Pharmaceutical

What do we know about medication for psychiatric use and its environmental risk?

Most pharmaceutical companies report on the impact of new psychiatric medication regarding the effects on the growth, mortality, and reproduction of species.

Although these pharmaceuticals alter wildlife behaviour, few studies are reported on behavioural changes. Moreover, the European Medicines Agency does not currently require studies on behavioural changes as part of the environmental risk assessment.

Photograph 1: by Mikael Stenberg on Unsplash

What will the concentration of antidepressants in drinking water in Stockholm, Sweden (Photograph 1) be, compared with drinking water on Itsukushima (Deer Island), Japan (Photograph 2)?

Photograph 2: courtesy of Kristian H. Reveles Jensen

I am wondering if someone can say how common depression or anxiety is in an area by measuring the concentration of medication in drinking water. It is probably not that simple to answer this question as there is a long way to go from seeking care to receiving antidepressant medication.

Antidepressant medications are usually prescribed for the treatment of depression, anxiety, or chronic pain.

One of the common behavioural effects of antidepressants in humans is reducing impulsivity, while a common side effect is decreasing libido.

Fluoxetine and citalopram are two of the most used antidepressants in Europe and USA and have consistently been reported in surface water and in very small amounts in our drinking water. Experimental studies suggest that fluoxetine can cause developmental delays in a species of amphibians (like frogs).

Furthermore, fluoxetine can alter the behaviour of starlings and of different species of fish. In fish, antidepressants (fluoxetine, sertraline, venlafaxine, citalopram and bupropion) could also reduce aggressive behaviour and affect the feeding and reproductive behaviours.

Other potent and widely used anxiolytics — medications which help reduce anxiety — include benzodiazepines such as oxazepam and diazepam. These medications persist in wastewater and are resistant to any breakdown by sunlight and air (known as the photodegradation process). This means that these medications remain, though in relatively low concentrations, in the aquatic environment.

Studies from Sweden reported that oxazepam, a widely used benzodiazepine, increases the migration pattern of salmon and alters the behaviour and feeding rates of wild European perch, another type of fish.

What can be done by patients and clinicians?

The Swedish Prescribing Guide (FASS.se ) have some tips to minimise the environmental impact:

1. Prescribe a small number of tablets when a patient tries a new medication

2. The patient information leaflet of many / most of the psychopharmacological drugs contains information on environmental risks. Doctors also need to create a routine in informing the patient on this issue as I am quite sure that in time clinicians will receive this question a lot more often.

3. Patients should be informed that no medication should be discarded among household waste or flushed in the toilet.

4. Leftover drugs and pharmaceutical packing (such as aerosol containers, powder inhalers, vials and ampoules, packaging containing infusion fluids, depot injections, depot patches, vaginal rings etc) should be returned to pharmacies for disposal.

5. Empty pharmaceutical packing should be sorted as other household garbage.

6. Become a volunteer and support research and campaigns on assessing the environmental risk of our pharmaceuticals.

How about the manufacturing of medications?

In this blog, I have discussed mainly medications which are prescribed for personal use. The reality of the matter is that a large proportion of the pharmaceuticals found in waters around the world are the result of the manufacturing process.

There is generally a lack of regulation on how much pharmaceutics can be eliminated in the waste waters close to the pharmaceutical factories. For more information on this topic please watch this talk of Professor Joakim Larsson from Gothenburg University, Sweden.

And, while doing research for this blog, I found a wonderful short film which highlights what I want to leave you with as a take home message.

From Charles Darwin’s time and his “On the origin of the species”, we know that the fittest have the highest chances to survive. We are the result of a permanent interaction between the genetic material from our parents and the environment. Given the rapidity with which human activity is impacting our environment including modifying the genetic material of other species, I am wondering where these changes will lead to.

It looks like in the era of Anthropocene (the Human Era ) everything is possible.

But do we really want to transform the useful frog in a handsome prince that we do not need?