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World J Psychiatr. Oct 19, 2021; 11(10): 791-804
Published online Oct 19, 2021. doi: 10.5498/wjp.v11.i10.791
Environmental pollution with psychiatric drugs
Julene Argaluza, Saioa Domingo-Echaburu, Gorka Orive, Juan Medrano, Rafael Hernandez, Unax Lertxundi
Julene Argaluza, Department of Epidemiology and Public Health, Bioaraba Health Research Institute, Vitoria-Gasteiz 01002, Spain
Saioa Domingo-Echaburu, Department of Pharmacy, Alto Deba Integrated Health Care Organization, Arrasate 20500, Spain
Gorka Orive, NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain
Gorka Orive, Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz 01006, Spain
Gorka Orive, Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz 01006, Spain
Gorka Orive, Singapore Eye Research Institute, Discovery Tower, Singapore 168751, Singapore
Juan Medrano, Department of Psychiatry, Biocruces Bizkaia Health Research Institute, Mental Health Network Research Group, Osakidetza, Portugalete 48920, Spain
Rafael Hernandez, Department of Internal Medicine, Araba Mental Health Network, Vitoria-Gasteiz 01006, Spain
Unax Lertxundi, Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz 01006, Alava, Spain
Author contributions: All authors participated in the work to take public responsibility for its content, provided substantial contributions to conception and design of the manuscript, contributed to drafting the article and revising it critically for important intellectual content and provided final approval of the version that was submitted.Both Julene-Argaluza and Saioa Domingo-Echaburu contributed equally to the work.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Unax Lertxundi, PhD, Chief Pharmacist, Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Calle Alava 43, Vitoria-Gasteiz 01006, Alava, Spain. unax.lertxundietxebarria@osakidetza.net
Received: February 23, 2021
Peer-review started: February 23, 2021
First decision: June 18, 2021
Revised: June 18, 2021
Accepted: August 31, 2021
Article in press: August 31, 2021
Published online: October 19, 2021
Processing time: 233 Days and 21.1 Hours
Abstract

Among all contaminants of emerging interest, drugs are the ones that give rise to the greatest concern. Any of the multiple stages of the drug's life cycle (production, consumption and waste management) is a possible entry point to the different environmental matrices. Psychiatric drugs have received special attention because of two reasons. First, their use is increasing. Second, many of them act on phylogenetically highly conserved neuroendocrine systems, so they have the potential to affect many non-target organisms. Currently, wastewater is considered the most important source of drugs to the environment. Furthermore, the currently available wastewater treatment plants are not specifically prepared to remove drugs, so they reach practically all environmental matrices, even tap water. As drugs are designed to produce pharmacological effects at low concentrations, they are capable of producing ecotoxicological effects on microorganisms, flora and fauna, even on human health. It has also been observed that certain antidepressants and antipsychotics can bioaccumulate along the food chain. Drug pollution is a complicated and diffuse problem characterized by scientific uncertainties, a large number of stakeholders with different values and interests, and enormous complexity. Possible solutions consist on acting at source, using medicines more rationally, eco-prescribing or prescribing greener drugs, designing pharmaceuticals that are more readily biodegraded, educating both health professionals and citizens, and improving coordination and collaboration between environmental and healthcare sciences. Besides, end of pipe measures like improving or developing new purification systems (biological, physical, chemical, combination) that eliminate these residues efficiently and at a sustainable cost should be a priority. Here, we describe and discuss the main aspects of drug pollution, highlighting the specific issues of psychiatric drugs.

Keywords: Antipsychotics; Pharmaceuticals in the environment; Drug pollution; Antidepressants; Wastewater; Ecotoxicity

Core Tip: Psychiatric drugs have received special attention as contaminants of emerging interest because of two reasons: First, their use is increasing. Second, many act on phylogenetically conserved neuroendocrine systems, potentially affecting many non-target organisms. Drug pollution is a complicated problem involving many stakeholders with different values and interests. Solutions can be applied at source, using medicines more rationally, prescribing greener drugs or designing pharmaceuticals that are more biodegradable. Besides, end of pipe measures, e.g., developing new purification systems will also be crucial. Finally, educating both health professionals and citizens, and collaboration between environmental and healthcare sciences is going to be essential.