Download PDF
Pharmacopsychiatry 2017; 50(05): 173-181
DOI: 10.1055/s-0043-113572
Review
© Georg Thieme Verlag KG Stuttgart · New York

Driving Under the Influence of Antidepressants: A Systematic Review and Update of the Evidence of Experimental and Controlled Clinical Studies

Alexander Brunnauer
1   kbo-Inn-Salzach-Klinikum, Psychiatric Hospital, Wasserburg/Inn, Germany
2   Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
,
Gerd Laux
2   Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
3   Institute of Psychological Medicine (IPM) Soyen, Germany
› Author Affiliations
Further Information

Publication History

received 20 March 2017
revised 05 June 2017

accepted 07 June 2017

Publication Date:
17 July 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Introduction This review provides an update of experimental and clinical studies on the effects of antidepressants on driving performance.

Methods A systematic literature search on the PubMed database (1980–2016) was performed.

Results Twenty-eight studies could be included in this review, whereas only 5 studies investigated driving performance under antidepressants in patients. Most tri- and tetracyclics have acute deleterious effects on driving performance that, except for mianserin, attenuate after subchronic use. Selective serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitor’s venlafaxine and milnacipran did not affect driving ability. Trazodone appears to have dose-related acute effects on driving skills. Acute use of mirtazapine does produce impairments that diminish when given as a nocturnal dose and cannot be seen in healthy subjects when initially given as a low dose or after repeated dosing. Additive effects with alcohol were most pronounced with sedating antidepressants. Most patients definitely benefit from treatment with newer antidepressants with respect to driving skills.

Discussion Much more patient studies are needed to elucidate a crucial question: from which antidepressant treatment do patients benefit most with respect to driving performance?

Key words

antidepressants - depression - driving performance
 

  • References

  • 1 Edwards JD, Bart E, O’Connor ML. et al. Ten years down the road: predictors of driving cessation. Gerontologist 2010; 50: 393-399
    CrossrefPubMedGoogle Scholar
  • 2 Brunnauer A, Buschert V, Segmiller F. et al. Mobility behaviour and driving status of patients with mental disorders – an exploratory study. Int J Psychiatry Clin Pract 2016; 20: 40-46
    CrossrefPubMedGoogle Scholar
  • 3 Elvik R. Risk of road accident associated with the use of drugs: a systematic review and meta-analysis of evidence from epidemiological studies. Accid Anal Prev 2013; 60: 254-267
    CrossrefPubMedGoogle Scholar
  • 4 Barbone F, McMahon AD, Davey PG. et al. Association of road-traffic accidents with benzodiazepine use. Lancet 1998; 352: 1331-1336
    CrossrefPubMedGoogle Scholar
  • 5 Gibson JE, Hubbard RB, Smith CJ. et al. Use of self-controlled analytical techniques to assess the association between use of prescription medications and the risk of motor vehicle crashes. Am J Epidemiol 2009; 169: 761-768
    CrossrefPubMedGoogle Scholar
  • 6 Bramness JG, Skurtveit S, Neutel CI. et al. Minor increase in risk of road traffic accidents after prescriptions of antidepressants: a study of population registry data in Norway. J Clin Psychiatry 2008; 69: 1099-1103
    CrossrefPubMedGoogle Scholar
  • 7 Ravera S, van Rein N, de Gier J. et al. Road traffic accidents and psychotropic medication use in the Netherlands: A case-control study. Br J Clin Pharmacol 2011; 72: 505-513
    CrossrefPubMedGoogle Scholar
  • 8 Ray WA, Fought RL, Decker MD. Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am J Epidemiol 1992; 136: 873-883
    CrossrefPubMedGoogle Scholar
  • 9 Leveille SG, Buchner DM, Koepsell TD. et al. Psychoactive medications and injurious motor vehicle collisions involving older drivers. Epidemiology 1994; 5: 591-598
    CrossrefPubMedGoogle Scholar
  • 10 Rock PL, Roiser JP, Riedel WJ. et al. Cognitive impairment in depression: A systematic review and meta-analyses. Psychol Med 2014; 44: 2029-2040
    CrossrefPubMedGoogle Scholar
  • 11 Brunnauer A, Laux G, Geiger E. et al. Antidepressants and driving ability: Results from a clinical study. J Clin Psychiatry 2006; 67: 1776-1781
    CrossrefPubMedGoogle Scholar
  • 12 Ramaekers JG. Antidepressants and driver impairment: Empirical evidence from a standard on-the-road test. J Clin Psychiatry 2003; 64: 20-29
    CrossrefPubMedGoogle Scholar
  • 13 Rosenblat JD, Kakar R, McIntyre R. The cognitive effects of antidepressants in major depressive disorder: A systematic review and meta-analysis of randomized clinical trials. Int J Neuropsychopharmacol 2015; 19: 1-13
    PubMedGoogle Scholar
  • 14 Keefe RSE, Mc Clintock SM, Roth RM. et al. Cognitive effects of pharmacotherapy for major depressive disorder: a systematic review. J Clin Psychiatr 2014; 75: 864-876
    CrossrefPubMedGoogle Scholar
  • 15 Rapoport MJ, Baniña MC. Impact of psychoactive medicines on simulated driving: a critical review. CNS Drugs 2007; 21: 503-519
    CrossrefPubMedGoogle Scholar
  • 16 Strand MC, Gjerde H, Mørland J. Driving under the influence of non-alcohol drugs – an update. Part II: experimental studies. Forensic Sci Rev 2016; 28: 79-101
    PubMedGoogle Scholar
  • 17 Brunnauer A, Laux G. The effects of most commonly prescribed second generation antidepressants on driving ability: A systematic review. J Neural Transm 2013; 120: 225-232
    CrossrefPubMedGoogle Scholar
  • 18 Herberg KW. Antidepressiva und Verkehrssicherheit. Fortschr Neurol Psychiat (Sonderheft 1) 1994; 62: 24-28
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Hindmarch I. Three antidepressants (amitriptyline, dothiepin, fluoxetine), with and without alcohol, compared with placebo on tests of psychomotor ability related to car driving. Hum Psychopharmacol 1987; 2: 177-183
    CrossrefPubMedGoogle Scholar
  • 20 Hindmarch I, Harrison C. The effects of paroxetine and other antidepressants in combination with alcohol in psychomotor activity related to car driving. Hum Psychopharmacol 1988; 3: 3-20
    CrossrefPubMedGoogle Scholar
  • 21 Mattila M, Sarialho-Kere U, Mattila M. Acute effects of sertraline, amitriptyline, and placebo on the psychomotor performance of healthy subjects over 50 years of age. J Clin Psychiatry 1988; 49 (Suppl. 08) 52-58
    PubMedGoogle Scholar
  • 22 Iwamoto K, Takahashi M, Nakamura Y. et al. The effects of acute treatment with paroxetine, amitriptyline, and placebo on driving performance and cognitive function in healthy Japanese subjects: A double-blind crossover trial. Hum Psychopharmacol Clin Exp. 2008; 23: 399-407
    CrossrefPubMedGoogle Scholar
  • 23 Hindmarch I, Subhan Z, Stoker MJ. The effects of zimeldine and amitriptyline on car driving and psychomotor performance. Acta Psychiatr Scand Suppl 1983; 308: 141-146
    PubMedGoogle Scholar
  • 24 Ridout F, Hindmarch I. Effects of tianeptine and mianserin on car driving skills. Psychopharmacology 2001; 154: 356-361
    CrossrefPubMedGoogle Scholar
  • 25 Ramaekers JG, Swijgman HF, O’Hanlon JF. Effects of moclobemide and mianserin on highway driving, psychometric performance and subjective parameters, relative to placebo. Psychopharmacology 1992; 106 Suppl S62-S67
    CrossrefPubMedGoogle Scholar
  • 26 Ramaekers JG, van Veggel LM, O’Hanlon JF. A cross-study of the effects of moclobemide and brofaromine on actual driving performance and estimated sleep. Clin Neuropharmacol 1994; 17 (Suppl. 01) S9-S19
    CrossrefPubMedGoogle Scholar
  • 27 O’Hanlon JF, Robbe HWJ, Vermeeren A. et al. Venlafaxine’s effects on healthy volunteers’ driving, psychomotor, and vigilance performance during 15-day fixed and incremental dosing regimens. J Clin Psychopharmacol 1998; 18: 212-221
    CrossrefPubMedGoogle Scholar
  • 28 Robbe HWJ, O’Hanlon JFO. Acute and subchronic effects of paroxetine 20 and 40 mg on actual driving, psychomotor performance and subjective assessments in healthy volunteers. Eur Psychopharmacol 1995; 5: 35-42
    PubMedGoogle Scholar
  • 29 van Laar MW, van Willigenburg AP, Volkerts ER. Acute and subchronic effects of nefazodone and imipramine on highway driving, cognitive functions, and daytime sleepiness in healthy adult and elderly subjects. J Clin Psychopharmacol. 1995; 15: 30-40
    CrossrefPubMedGoogle Scholar
  • 30 Ramaekers JG, Muntjewerf ND, Van Veggel MA. et al. Effects of nocturnal doses of mirtazapine and mianserin on sleep and on daytime psychomotor and driving performance in young, healthy volunteers. Hum Psychopharmacol Clin Exp 1998; 13: 87-97
    CrossrefPubMedGoogle Scholar
  • 31 Ramaekers JG, Muntjewerf ND, O’Hanlon JFO. A comparative study of acute and subchronic effects of dothiepin, fluoxetine and placebo on psychomotor and actual driving performance. Br J Clin Pharmacol 1995; 39: 397-404
    CrossrefPubMedGoogle Scholar
  • 32 Veldhuijzen DS, van Wijck AJ, Verster JC. et al. Acute and subchronic effects of amitriptyline 25mg on actual driving in chronic neuropathic pain patients. J Psychopharmacol 2006; 20: 782-788
    CrossrefPubMedGoogle Scholar
  • 33 Brunnauer A, Buschert V, Fric M. et al. Driving performance and psychomotor function in depressed patients treated with agomelatine or venlafaxine. Pharmacopsychiatry 2015; 48: 65-71
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Herberg KW. Verkehrs- und Alltagssicherheit bei Medikation mit Citalopram. Psychopharmakotherapie 2001; 8: 81-88
    PubMedGoogle Scholar
  • 35 Wingen M, Bothmer J, Langer S. et al. Actual driving performance and psychomotor function in healthy subjects after acute and subchronic treatment with escitalopram, mirtazapine, and placebo: a crossover trial. J Clin Psychiatry 2005; 66: 436-443
    CrossrefPubMedGoogle Scholar
  • 36 Wilson SJ, Bailey JE, Alford C. et al. Effects of 5 weeks of administration of fluoxetine and dothiepin in normal volunteers on sleep, daytime sedation, psychomotor performance and mood. J Psychopharmacol 2002; 16: 321-331
    CrossrefPubMedGoogle Scholar
  • 37 Linnoila M, Stapleton JM, George DT. et al. Effects of fluvoxamine, alone and in combination with ethanol, on psychomotor and cognitive performance and on autonomic nervous system reactivity in healthy volunteers. J Clin Psychopharmacol 1993; 13: 175-180
    PubMedGoogle Scholar
  • 38 Theunissen EL, Street D, Hoyer AM. et al. A randomized trial on the acute and steady-state effects of a new antidepressant, vortioxetine (Lu AAA21004), on actual driving and cognition. Clin Pharmacol Ther 2013; 93: 493-501
    CrossrefPubMedGoogle Scholar
  • 39 Sasada K, Iwamoto K, Kawano N. Effects of repeated dosing with mirtazapine, trazodone, or placebo on driving performance and cognitive function in healthy volunteers. Hum Psychopharmacol Clin Exp. 2013; 28: 281-286
    CrossrefPubMedGoogle Scholar
  • 40 Roth AJ, McCall WV, Liguori A. Cognitive, psychomotor and polysomnographic effects of trazodone in primary insomniacs. J Sleep Res 2011; 20: 552-558
    CrossrefPubMedGoogle Scholar
  • 41 Richet F, Marais J, Serre C. et al. Effects of milnacipran on driving vigilance. Int J Psychiatry Clin Pract 2004; 8: 109-115
    CrossrefPubMedGoogle Scholar
  • 42 Brunnauer A, Laux G, David I. et al. The impact of reboxetine and mirtazapine on driving simulator performance and psychomotor function in depressed patients. J Clin Psychiatry 2008; 69: 1880-1886
    CrossrefPubMedGoogle Scholar
  • 43 Ridout F, Meadows R, Johnsen S. et al. A placebo controlled investigation into the effects of paroxetine and mirtazapine on measures related to car driving performance. Hum Psychopharmacol Clin Exp 2003; 18: 261-269
    CrossrefPubMedGoogle Scholar
  • 44 Iwamoto K, Kawano M, Sasada K. et al. Effects of low-dose mirtazapine on driving performance in healthy volunteers. Hum Psychopharmacol Clin Exp 2013; 28: 523-528
    CrossrefPubMedGoogle Scholar
  • 45 Shen J, Moller HJ, Wang X. et al. Mirtazapine, a sedating antidepressant, and improved driving safety in patients with major depressive disorder: A prospective, randomized trial of 28 patients. J Clin Psychiatry 2009; 70: 370-377
    CrossrefPubMedGoogle Scholar
  • 46 Liberati A, Douglas DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol 2009; 62: e1-e34
    CrossrefPubMedGoogle Scholar