Antidepressants and Driving

Definition of Depression

Depression is a mood disorder that may cause a persistent feeling of sadness and loss of interest.

It is also known as major depressive disorder or clinical depression and it affects how you feel, think and behave and is often associated with a variety of emotional and physical problems.(1)

Symptoms, Causes, Risk Factors, Complications, Tests and Diagnosis, Treatment and Drugs, Lifestyle and Remedies, Alternative Medicine, Coping and Support.

The Mayo Clinic provides an excellent summary of all these important matters pertaining to the diagnosis and optimum treatment of depression. (2-10)

Effect of Antidepressants on Elderly Drivers

D.H. Cameron and colleagues conducted a systematic review of MEDLINE articles on antidepressants and driving in the population or subgroup of those aged 55 years or over. (11)

Of the 267 references they identified 9 that pertained to the effects of antidepressants on driving in this population.

Their findings showed that imipramine had detrimental effects on highway driving while nefazadone did not.

Furthermore 7 of 8 population-based studies reported a significant increased risk of involvement in a collision associated with antidepressant use.

In the interpretation of their results, they emphasised that epidemiological designs could not exclude the possibility that the underlying illness which was generally major depression could be the main culprit.

Interestingly, J P Fournier and colleagues examined the concurrent use of Benzodiazepines and Antidepressants to evaluate the risk of motor vehicle accidents in older drivers. (12)

Their nested case-controlled study used a cohort of drivers aged 67-84 years from the Societe de Assurance Automobile du Quebec and the Regie de Assurance Maladie du Quebec data bases during the period from 1990 to 2000.

They matched first cases of motor vehicle accidents (MVA’s) during follow up with up to 10 controls from the cohort.

The authors estimated Odds ratios (ORs) for the association between motor vehicle accidents and the use of benzodiazepines and antidepressants by using conditional logistic regression.

This large cohort included 373,818 drivers, with 74,503 MVA cases matched with 744,663 controls.

The risk of MVA was higher in current users of long-acting benzodiazepines [OR 1.23; 95% confidence interval (CI) 1.16-1.29] than in current users who consume short-acting benzodiazepines (OR 1.05; 95% CI 1.02-1.08).

The risk of MVA was increased in current users of selective serotonin reuptake inhibitors (SSRIs; OR 1.13; 95% CI 1.04-1.22), but not in current users of tricyclic antidepressants (TCAs; OR 1.04; 95% CI 0.96-1.14).

The highest ORs of MVA were found in long-acting benzodiazepines users concurrently using SSRIs (OR 1.37; 95% CI 1.07-1.77, P value for interaction = 0.964) or TCAs (OR 1.54; 95% CI 1.21-1.95, P value for interaction = 0.077).

Conclusion

These authors concluded that the use of long-acting benzodiazepines was associated with an increased risk of MVA in the elderly, especially those concurrently using SSRIs or TCAs.

The use and safety of medications known to affect driving in Jordan

A recent study in Jordan found a disturbingly high incidence of sleepiness and associated high accident rate for motor vehicle drivers. (13)

These authors goal was to estimate the main driving-impairing medications used by drivers in Jordan, the reported frequency of medication side effects, the frequency of motor vehicle crashes (MVCs) while using driving-impairing medicines, as well as factors associated with MVCs.

E Elayeh and colleagues utilised a cross-sectional study involving 1,049 individuals (age 18-75 years) who were actively driving vehicles and taking at least one medication known to affect driving.

They examined the use of anxiolytics, hypnotics, antidepressants, antiepileptics, opioids, sedating antihistamines, hypoglycemic agents, antihypertensives, central nervous system [CNS] stimulants, and herbals with CNS-related effects).

This study was conducted in Amman, Jordan, over a period of 8 months (September 2013-May 2014) using a structured validated questionnaire.

Interestingly, 63% of participants noticed a link between a medicine taken and feeling sleepy and 57% stated that they experienced at least one adverse effect other than sleepiness from their medication.

 Approximately 22% of the participants reported having a MVC while on medication.

 Multiple logistic regression analysis showed that among the participants who reported having a crash while taking a driving-impairing medication, the odds ratios were significantly higher for the use of inhalant substance (odds ratio [OR] = 2.787, P = .014), having chronic conditions (OR = 1.869, P = .001), and use of antiepileptic medications (OR = 2.348, P = .008).

They were also significantly lower for the use of antihypertensives (OR = 0.533, P = .008). 

CONCLUSION: 

These latest results confirm the high prevalence of adverse effects of medications with potential for driving impairment, including involvement in MVCs.

The findings of a 22% incidence of motor vehicle accident rate for patients while taking drugs that can impair driving, support previous results of almost a 33% motor vehicle accident rate for schizophrenic patients who drive cars. (14)

We must continue to accelerate research to find minimally sedating drugs in all therapeutic areas if we are to save lives, reduce serious trauma injuries and property damage due to patients taking sedating medications.

References:

(1) Depression (major depressive disorder). 1998-2016 Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/depression/basics/definition/con-20032977

(2) Symptoms of Depression. 1998-2016 Mayo Foundation for Medical Education and Research.https://www.mayoclinic.org/diseases-conditions/depression/basics/symptoms/con-20032977.

(3) Causes.1998-2016 Mayo Foundation for Medical Education and Research https://www.mayoclinic.org/diseases-conditions/depression/basics/causes/con-20032977

(4) Risk Factors. 1998-2016 Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/depression/basics/risk-factors/con-20032977

(5) Complications.1998-2016 Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/depression/basics/complications/con-20032977

(6) Tests and Diagnosis. 1998-2016 Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/depression/basics/tests-diagnosis/con-20032977

(7) Treatment and Drugs. 1998-2016 Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/depression/basics/treatment/con-20032977

(8) Lifestyle and Home Remedies. 1998-2016 Mayo Foundation for Medical Education and Research https://www.mayoclinic.org/diseases-conditions/depression/basics/lifestyle-home-remedies/con-20032977

(9) Alternative Medicine. 1998-2016 Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/depression/basics/alternative-medicine/con-20032977

(10) Coping and Support. 1998-2016 Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/depression/basics/coping-support/con-20032977

(11) Cameron DH, Rapoport MJ. Antidepressants and Driving in Older Adults: A Systematic Review. Can. J Aging 2016 Apr 19:1-8. [Epub ahead of print]

(12) Fournier JP, Wilchesky M, Patenaude V, Suissa S. Concurrent Use of Benzodiazepines and Antidepressants and the Risk of Motor Vehicle Accident in Older Drivers: A Nested Case-Control Study. Neurol Ther. 2015 Jun; 4(1):39-51. doi: 10.1007/s40120-015-0026-0. Epub 2015 Mar 6.

(13) Elayeh E, Bulatova N, Basheti I, Farha RA, Al-Rawi N, Snaineh AA, Alahwal I. The use and safety of medications known to affect driving in Jordan: A cross-sectional study. Traffic Inj Prev.2016 Apr 2; 17(3):238-44. doi: 10.1080/15389588.2015.1065543. Epub 2015 Sep 30.

(14) Steinert T, Veit F, Schmid P, Jacob Snellgrove B, Borbé R. Participating in mobility: People with schizophrenia driving motorized vehicles. Psychiatry Res.2015 Aug 30; 228 (3):719-23. doi: 10.1016/j.psychres.2015.05.034. Epub 2015 Jun 6.