Scientists call for greener drugs and eco-prescribing

With ever growing attention on reducing carbon emissions becoming a focus for the world, many are looking to heat their homes with solar panels and buying electric cars, but did you know that the pharmaceutical industry is significantly more emission intensive than the automotive industry with the largest contribution to that footprint being prescription drug sectors and the hospital (14% and 39% respectively). In the United Kingdom a 2014 report found that the Social Care, Public Health and NHS total carbon footprint was 38% of emissions from the public sector and pharmaceuticals was the largest contributor accounting for 16.25% of that total footprint (Belkhir and Elmeligi, 2019). 

In addition, drug pollution is also affecting our environment, from bioaccumulation along the food chain and affecting tap water, even at low concentrations human health, flora and fauna, and microorganisms are producing ecotoxicological effects.

It is estimated that between 30% and 90% of unchanged drug is excreted in urine and faeces (Argaluza et al., 2021) with most wastewater treatment plants not having the necessary removal methods for pharmaceuticals to be eliminated (Diaz-Camal et al., 2022).

Psychiatric drugs are at the forefront of the problem due to their widespread use.

Anxiety and depression are on the rise with statistics showing that in 2017-2018, antidepressant prescriptions were written for 17% of the adult population (GOV.UK, 2020). Since the COVID-19 pandemic prevalence of depression and anxiety has increased by 25% worldwide (WHO, 2022) with studies showing the mental health crisis could remain for years (University of Edinburgh, 2022). 

To treat depression and anxiety SSRIs (Selective serotonin reuptake inhibitors) are often prescribed, but as discussed, the environmental impact of this includes ecotoxicological effects and high carbon footprint, therefore scientists are looking for alternate solutions such as eco-prescribing or prescribing greener drugs (Argaluza et al., 2021).

SSRIs (Selective serotonin reuptake inhibitors) are prescribed to increase serotonin levels in the brain, and it is considered heightened levels can improve symptoms of mental health conditions (NHS, 2021a). Hypericum perforatum (commonly known as St. John’s wort) is believed to work in a similar manner (Thornett, 2000). SSRIs have been available for prescription since the late 1980s (López-Muñoz and Alamo, 2009) and Hypericum perforatum has been noted for medicinal use in literature from as early as the first century AD (Istikoglou et al., 2010).

Side effects of taking SSRIs have been noted as headaches and insomnia, affecting sex drive, interfering with appetite, causing nausea and vomiting, causing irritability and anxiety, and to a smaller degree they can induce spasms and tics, and parkinsonism (Pereira and Hiroaki-Sato, 2018). Discontinuation rates of taking SSRIs is around 73% due to side effects and lack of efficacy (Jung et al., 2016). Side effects of taking Hypericum perforatum are usually minor and uncommon but have been reported as insomnia, increased sensitivity to sunlight, dizziness, gastrointestinal symptoms, dry mouth, headache, sexual dysfunction or fatigue (NIH, 2020). However, comparison of conventional antidepressants with Hypericum perforatum has shown the incidence of adverse reactions from Hypericum perforatum to be 27% lower (Ernst et al., 2014). 

Clinical trials have shown that 91% of the time Hypericum is as effective or more effective than SSRIs, showing that this particular herb has a lot to offer, not just in the treatment of anxiety and depression but, in addition, also to the environment. Hypericum perforatum may provide a valuable eco system service with specific note on pollination from bumble bees (Drummond, 2019) and it is classed as an invasive plant in many countries as there is an abundance of it (Popay, 2015). 

So are there any downsides?

It is widely noted that Hypericum increases cytochrome P450 3A4 (CYP3A4) activity and has the potential to interact with other prescription drugs (Komoroski, 2004). This has caused some concern over its intake, however SSRIs also have the ability to cause drug-drug interactions through cytochrome-P450 (CYP) isoforms inhibition (Hemeryck and Belpaire, 2002) therefore the prescription of any SSRIs combined with other drug combinations should be assessed on an individual basis, as they should with a prescription of Hypericum. 

So if you are looking to take Hypericum perforatum please be advised to see a qualified herbalist who can check any potential interactions to ensure safety at all times.