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‘Prescribing’ psychotropic medication to our rivers and estuaries

  • Alex T. Ford (a1) and Helena Herrera (a1)



The 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 interest


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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Correspondence to Alex T. Ford (


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1Busfield, J. Assessing the overuse of medicines. Soc Sci Med 2015; 131: 199206.
2Nutt, DJ. Drugs – Without the Hot Air: Minimising the Harms of Legal and Illegal Drugs. UIT Cambridge, 2012.
3Bachmann, CJ, Aagaard, L, Burcu, M, Glaeske, G, Kalverdijk, LJ, Petersen, I. Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005–2012. Eur Neuropsychopharmacol 2016; 26: 411–9.
4Friedman, RA. Antidepressants’ black-box warning – 10 years later. N Engl J Med 2014; 371: 1666–8.
5Hignite, C, Azarnoff, D. Drugs and drug metabolites as environmental contaminants: chlorophenoxyisobutyrate and salicylic acid in sewage water effluent. Life Sci 1977; 20: 337–42.
6Richarson, ML, Bowron, JM. The fate of pharmaceutical chemicals in the aquatic environment. J Pharm Pharmacol 1985; 37: 112.
7Calisto, V, Esteves, VI. Psychiatric pharmaceuticals in the environment. Chemosphere 2009; 77: 1257–74.
8Boxall, AB. The environmental side effects of medication. EMBO Rep 2004; 5: 1110–6.
9Hird, CM, Urbina, MA, Lewis, CN, Snape, JR, Galloway, TS. Fluoxetine exhibits pharmacological effects and trait-based sensitivity in a marine worm. Environ Sci Technol 2016; 50: 8344–52.
10Calisto, V, Domingues, MRM, Esteves, VI. Photodegradation of psychiatric pharmaceuticals in aquatic environments – kinetics and photodegradation products. Water Res 2011; 45: 6097–106.
11Waggott, A. Trace organic substances in the River Lee. In Chemistry in Water Reuse (ed. Cooper, J). Arbor Publishers Inc, 1981.
12Brausch, JM, Connors, KA, Brooks, BW, Rand, GM. Human pharmaceuticals in the aquatic Environment: a review of recent toxicological studies and considerations for toxicity testing. In Reviews of Environmental Contamination and Toxicology (ed. Whitacre, D). Springer, 2012.
13Chen, M, Ohman, K, Metcalfe, C, Ikonomou, MG, Amatya, PL, Wilson, J. Pharmaceuticals and endocrine disruptors in wastewater treatment effluents and in the water supply system of Calgary, Alberta, Canada. Water Qual Res J Can 2006; 41: 351–65.
14Green, RE, Newton, I, Shultz, S, Cunningham, AA, Gilbert, M, Pain, DJ, et al. Diclofenac poisoning as a cause of vulture population declines across the Indian subcontinent. J Appl Ecol 2004; 41: 793800.10.1111/j.0021-8901.2004.00954.x
15Saussereau, E, Lacroix, C, Guerbet, M, Cellier, D, Spiroux, J, Goullé, GJ. Determination of levels of current drugs in hospital and urban wastewater. Bull Env Contam Toxicol 2013; 91: 171–6.
16Fong, PP, Ford, AT. The biological effects of antidepressants on the molluscs and crustaceans: a review. Aquat Toxicol 2014; 151: 413.
17Guler, Y, Ford, AT. Anti-depressants make amphipods see the light. Aquat Toxicol 2010; 99: 397404.
18Di Poi, C, Darmaillacq, AS, Dickel, L, Boulouard, M, Bellanger, C. Effects of perinatal exposure to waterborne fluoxetine on memory processing in the cuttlefish Sepia officinalis. Aquat Toxicol 2013; 132: 8491.
19De Lange, HJ, Peeters, ETHM, Lürling, M. Changes in ventilation and locomotion of Gammarus pulex (Crustacea, Amphipoda) in response to low concentrations of pharmaceuticals. Hum Ecol Risk Assess An Int J 2009; 15: 111–20.
20Fong, PP. Zebra mussel spawning is induced in low concentrations of putative serotonin reuptake inhibitors. Biol Bull 1998; 194: 143–9.
21Fong, PP, Hoy, CM. Antidepressants (venlafaxine and citalopram) cause foot detachment from the substrate in freshwater snails at environmentally relevant concentrations. Mar Freshw Behav Physiol 2012; 45: 145–53.
22Fong, PP, Molnar, N. Antidepressants cause foot detachment from substrate in five species of marine snail. Mar Environ Res 2013; 84: 2430.
23Fingerman, M. Roles of neurotransmitters in regulating reproductive hormone release and gonadal maturation in decapod crustaceans. Invertebr Reprod Dev 1997; 31: 4754.
24Hsieh, SL, Chen, SM, Yang, YH, Kuo, CM. Involvement of norepinephrine in the hyperglycemic responses of the freshwater giant prawn, Macrobrachium rosenbergii, under cold shock. Comp Biochem Physiol Part A Mol Integr Physiol 2006; 143: 254–63.
25Robert, A, Monsinjon, T, Delbecque, J-P, Olivier, S, Poret, A, Foll, FL, et al. Neuroendocrine disruption in the shore crab Carcinus maenas: effects of serotonin and fluoxetine on chh- and mih-gene expression, glycaemia and ecdysteroid levels. Aquat Toxicol 2016; 175: 192204.
26Stewart, AM, Braubach, O, Spitsbergen, J, Gerlai, R, Kalueff, AV. Zebrafish models for translational neuroscience research: from tank to bedside. Trends Neurosci 2014; 37: 264–78.
27Stewart, A, Gaikwad, S, Kyzar, E, Green, J, Roth, A, Kalueff, AV. Modeling anxiety using adult zebrafish: a conceptual review. Neuropharmacology 2012; 62: 135–43.
28Levin, ED, Bencan, Z, Cerutti, DT. Anxiolytic effects of nicotine in zebrafish. Physiol Behav 2007; 90: 54–8.
29Blaser, RE, Rosemberg, DB. Measures of anxiety in zebrafish (Danio rerio): dissociation of black/white preference and novel tank test. PLoS One 2012; 7: e36931.
30Kohlert, JG, Mangan, BP, Kodra, C, Drako, L, Long, E, Simpson, H. Decreased aggressive and locomotor behaviors in Betta splendens after exposure to fluoxetine. Psychol Rep 2012; 110: 5162.
31Forsatkar, MN, Nematollahi, MA, Amiri, BM, Huang, W-B. Fluoxetine inhibits aggressive behaviour during parental care in male fighting fish (Betta splendens, Regan). Ecotoxicology 2014; 23: 1794–802.
32Kidd, KA, Blanchfield, PJ, Mills, KH, Palace, VP, Evans, RE, Lazorchak, JM, et al. Collapse of a fish population after exposure to a synthetic estrogen. Proc Natl Acad Sci 2007; 104: 8897–901.
33Weinberger, J, Klaper, R. Environmental concentrations of the selective serotonin reuptake inhibitor fluoxetine impact specific behaviors involved in reproduction, feeding and predator avoidance in the fish Pimephales promelas (fathead minnow). Aquat Toxicol 2014; 151: 7783.
34Painter, MM, Buerkley, MA, Julius, ML, Vajda, AM, Norris, DO, Barber, LB, et al. Antidepressants at environmentally relevant concentrations affect predator avoidance behavior of larval fathead minnows (Pimephales promelas). Environ Toxicol Chem 2009; 28: 2677.
35Mennigen, JA, Sassine, J, Trudeau, VL, Moon, TW. Waterborne fluoxetine disrupts feeding and energy metabolism in the goldfish Carassius auratus. Aquat Toxicol 2010; 100: 128–37.
36De Lange, HJ, Noordoven, W, Murk, AJ, Lurling, M, Peeters, ET. Behavioural responses of Gammarus pulex (Crustacea, Amphipoda) to low concentrations of pharmaceuticals. Aquat Toxicol 2006; 78: 209–16.
37Sánchez-Argüello, P, Fernández, C, Tarazona, JV. Assessing the effects of fluoxetine on Physa acuta (Gastropoda, Pulmonata) and Chironomus riparius (Insecta, Diptera) using a two-species water–sediment test. Sci Total Environ 2009; 407: 1937–46.
38Conners, DE, Rogers, ED, Armbrust, KL, Kwon, J-W, Black, MC. Growth and development of tadpoles (Xenopus laevis) exposed to selective serotonin reuptake inhibitors, fluoxetine and sertraline, throughout metamorphosis. Environ Toxicol Chem 2009; 28: 2671.
39Calabrese, EJ, Blain, RB. The hormesis database: the occurrence of hormetic dose responses in the toxicological literature. Regul Toxicol Pharmacol 2011; 61: 7381.
40Blanchfield, PJ, Kidd, KA, Docker, MF, Palace, VP, Park, BJ, Postma, LD. Recovery of a wild fish population from whole-lake additions of a synthetic oestrogen. Environ Sci Technol 2015; 49: 3136–44.
41Hicks, KA, Fuzzen, MLM, McCann, EK, Arlos, MJ, Bragg, LM, Kleywegt, S, et al. Reduction of intersex in a wild fish population in response to major municipal wastewater treatment plant upgrades. Environ Sci Technol 2017; 51: 1811–9.
42Owen, R, Jobling, S. Environmental science: the hidden costs of flexible fertility. Nature 2012; 485(7399): 441.
43Wang, S. Sustainability Frameworks: Green Chemistry and Sustainable Engineering in Pharmaceuticals. Taylor and Francis, 2018.
44Moncrieff, J. Against the stream: antidepressants are not antidepressants – an alternative approach to drug action and implications for the use of antidepressants. BJPsych Bull 2018; 42: 42–4.


‘Prescribing’ psychotropic medication to our rivers and estuaries

  • Alex T. Ford (a1) and Helena Herrera (a1)


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‘Prescribing’ psychotropic medication to our rivers and estuaries

  • Alex T. Ford (a1) and Helena Herrera (a1)
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