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Some APDs are classified as posing a high environmental risk, due, in part, to their tendency to bioaccumulate in wildlife, including fish. Additional risk drivers for APDs relate to their behavioural effects, potentially impacting fitness outcomes. However, standard ecotoxicological tests used in environmental risk assessment (ERA) do not currently account for these mechanisms. In this review, we critically appraise the environmental risks of APDs to fish. We begin by reading\u2010across from human and mammalian effects data to standard ecotoxicological effects endpoints in fish. We then explore the wide range of behaviours suitable for ecotoxicological assessment of APDs (and other neuroactive) pharmaceuticals, principally through laboratory studies with zebrafish, and assess the potential for using these behavioural phenotypes to predict adverse individual\u2010 and population\u2010level outcomes in wild fish, taking into account phenotypic plasticity. 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