Psychotropic drugs and the environment: a comprehensive analysis of surface water concentrations and associated risks

Introduction For most countries it is currently unknown to what degree concentrations of psychotropic drugs in surface water exceed environmental threshold (ETCs) [MOU1] for ecosystems and risk mitigation could be applied. ETCs are defined as per-compound above which detrimental effects on reproduction, growth, mortality aquatic organisms cannot exclude Objectives To quantify levels antidepressants, antipsychotics, mood stabilizers, benzodiazepines water, investigate their sources assess whether these ETCs. Methods: Design Cross-sectional analysis measured modeled data. Environmental were compared evaluate risks the environment. Finally, investigated. Setting All available Dutch monitoring data from all regional national campaigns 2019, last year before COVID-19 pandemic. Exposures Concentrations aripiprazole, carbamazepine its metabolites, clozapine, diazepam, (es)citalopram, fluoxetine, haloperidol, nortriptyline, olanzapine, oxazepam, temazepam, quetiapine, sertraline, valproic acid, venlafaxine. Main outcomes measures The main aforementioned agents water. As a secondary outcome, where possible, average quotients (RQs) calculated by dividing or ETC. An RQ > 1 was interpreted Results Psychotropic drug samples (n=1201; 14-520 measurements per drug) showed highest oxazepam (0.91 μg/L; = 1.89) (0.74 1.48), with individual exceeding other drugs, did not reach detection limit (amisulpride, venlafaxine) ETC (fluoxetine). Furthermore, households contributed psychotropics cleared less efficiently wastewater treatment plant than medications. Conclusions present primarily emitted households, may put at risk. We signal need reduce several Our findings set stage policies research aimed curtailing emissions into environment highlight responsible prescribing waste measures. Disclosure Interest None Declared