Environmentally conscious psychopharmacotherapy: Practice recommendations for psychiatrists

Despite the multifaceted negative influences of psychotropic medications on the environment, an overview of such effects and of actions to curtail them is currently lacking. We therefore summarized the most relevant literature on what we refer to as Environmentally Conscious Psychopharmacotherapy (ECP), i.e., prescribing the most appropriate psychotropic medications for patients while at the same time considering the wellbeing of the planet. In our literature appraisal we identified viable actions at the levels of industry, physicians, pharmacists, patients, and policymakers that can reduce the environmental hazards associated with psychotropics. We divided these actions into the following categories: careful treatment selection, curtailing overprescribing, adequate disposal of medication by users, and transparent reporting of environmental risk. For each of these categories, we give examples of practices are in line with ECP, which in turn has the potential to reduce the impact of psychotropic medication prescribing practices on the environment. We note that many such practices result in co-benefits for patients, prescribers and the environment. On the other hand, evidence on environmental impact is lacking for several factors related to these medications, e.g., geographical region of manufacturing, duration of use, pharmacological vs. non-pharmaceutical treatment options, and ecotoxicological data. We conclude that general as well as disorder-specific considerations for clinicians prescribing psychotropics already carry the potential to limit the environmental burden associated with these agents. Future research aimed at filling the knowledge gaps we identified is likely to substantially advance ECP in the near future.