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Table 2 Antidepressants and crash riska

From: Depression, antidepressants and driving safety

Lead author Year of publication Country Sample size Methodology Confounders Findings
(Orriols et al. 2012) 2012 France 34,896 cases, 37,789 controls Case-control to compare drivers responsible for crash and those not responsible for crash and case crossover analysis to compare exposure immediately before crash with exposure during earlier period (2005-2008) Adjusted: Gender, age, socioeconomic category, concomitant use of high risk medications, injury severity, blood alcohol concentration, use of sedative-hypnotics, time of day, accident type, responsibility of driver
Non-Adjusted: Data limited to those filed in police reports or database; antidepressant drug adherence not confirmed; lack of information on medical/psychiatric diagnoses
4% of all drivers exposed to 1 antidepressant on day of crash.
Antidepressant and risk of being responsible for crash:
All antidepressants (OR = 1.34, CI:1.22, 1.47),
TCAs (OR = 1.05, CI:0.81-1.36),
SSRI (OR = 1.30, CI: 1.16-1.46)*,
SNRI (OR = 1.51, CI: 1.25-1.84) p < .0001, other antidepressants (OR = 1.30, CI:1.01-1.67) (p < .05)
During period immediately before rash, increased risk of crash higher among antidepressant users with only 1 prescription (OR = 1.45, CI: 1.24-1.79)* and changes in antidepressant treatment (OR = 1.32, CI: 1.09-1.60)
(Orriols et al. 2013) 2013 Canada 109,406 (aged 66-84) Case cross-over analysis of those exposed to antidepressants immediately before road traffic crash and those exposed during earlier periods (first road crash between 1988-2000) Adjusted: Duration of treatment with antidepressant
Non-Adjusted: Antidepressant drug adherence not confirmed; no confirmation of psychiatric diagnoses corresponding to antidepressant prescription; no information on use of alcohol or illicit substances prior to crash in either group
2.7% exposed to antidepressant on day of crash and 20.1% had at least one antidepressant prescription over study period. Antidepressant prescription before crash increased risk of crash (OR = 1.19, CI: 1.08, 1.30) compared to antidepressant exposure 4-8 months before crash.
(Rapoport et al. 2011) 2011 Canada 159,678 (age ≥65) Population based case-only time to event (motor vehicle crash after 66th birthday) analysis (2000-2007) Adjusted: Gender, number of license suspensions before first collision, medication burden
Non-Adjusted: Limited to subjects 65 and older; antidepressant drug adherence not confirmed; no information on use of alcohol or illicit substances prior to crash
5% exposed to antidepressant in month prior to crash. Second generation antidepressants increased risk of crash (HR = 1.10,CI: 1.07, 1.13, p < 0.0001); benzodiazepines increased risk (adjusted HR = 1.05 (CI: 1.03-1.07, p < 0.0001) similarly to antidepressants. Increased risk apparent for first 3-4 months after antidepressant started.
(Sagberg 2006) 2006 Norway 4448 crash-involved drivers Case-control study using self-reported questionnaires Adjusted: Crash type, responsible for crash, psychiatric/medical illnesses, medication classes, symptoms that may influence car crash, driving experience
Non-Adjusted: Self-reports could underestimate use of antidepressants or presence of symptoms; medication adherence not confirmed; no confirmation of psychiatric/medical diagnoses; no information on use of alcohol or illicit substances
Use of antidepressants also increased risk (OR = 1.70, CI: 0.98-2.24)
(Bramness et al. 2008) 2008 Norway Of road accidents (20,494) with personal injuries, 204 drivers exposed to sedating antidepressants, 884 drivers exposed to non-sedating antidepressants (18-69 years) Retrospective analysis (2004- 2006) Adjusted: Gender, age,
Non-Adjusted: Antidepressant drug adherence not confirmed; lack of information on medical/psychiatric diagnoses; no information on alcohol or substance use; no information on driver responsibility or accident severity
Sedating antidepressants increased risk for traffic accidents (SIR = 1.4, CI:1.2, 1.6) and
non-sedating antidepressants increased risk for traffic accidents (SIR = 1.6, CI:1.5, 1.7). SIR did not change for different time periods after prescription dispensing, concomitant medication use or for new users.
(Hooper et al. 2010) 2010 US 962 fatal motor vehicle crash (cases) and 2886 (controls) (active duty military population) Case-Control (2002-2006) Adjusted: Gender, age, branch of service, rank, deployment
Non-Adjusted: Subjects limited to active duty military personnel; medication adherence not confirmed; medication consumed outside military health system not captured
Antidepressants were an independent mediator of fatal motor vehicle crashes (adjusted OR = 3.19,CI: 1.01, 10.07); “other mental disorders” also increased risk (adjusted OR = 2.28, CI: 1.41, 3.70)
(LeRoy & Morse 2008) 2008 US 5398 cases, 16,194 controls >50 Case-Control (1998-2000 and 1998-2002) Medication adherence not confirmed; duration of treatment not captured Serotonin-2 antagonist/reuptake inhibitors (OR = 1.90,CI: 1.49, 2.44)
SNRI: (OR = 1.78,CI: 1.19, 2.66)
(Gibson et al. 2009) 2009 UK 49821 Case Cross-over study Adjusted: Age, time of exposure to medication classes
Non-Adjusted: Medication adherence not confirmed; lack of information on medical/psychiatric diagnoses; use of alcohol and other substances not captured
SSRI short term use IRR = .92 (99% CI: .75-1.12); extended use IRR = 1.16 (99% CI: 1.06-1.28).
(Barbone et al. 1998) 1998 UK 19386 crashes Case Cross-over study Adjusted: Age, gender, severity of injuries, time of day, lighting conditions, number of vehicles involved, driver at fault, breath alcohol test
Non-Adjusted: Medication adherence not confirmed; lack of information on medical/psychiatric diagnoses
TCA and SSRI antidepressants had no association.
TCA OR = .93 (CI:.72-1.21); SSRI OR = .85 (CI: .55-1.33)
(Ravera et al. 2011) 2011 Netherlands 3963 cases
18828 controls
Case-control study Adjusted: Age, gender, season, weather, time of accident, lighting conditions, severity of accident
Non-Adjusted: Medication adherence not confirmed; cases limited to those who required medical assistance from the traffic accident; cases limited to those who were negative for alcohol use; lack of information on medical/psychiatric diagnoses
SSRI OR = 2.03 (CI:1.31-3.14)
  1. a SIR standardized incidence ratios, CI confidence interval, OR odds ratio, SSRI selective serotonin reuptake inhibitor, TCA tricyclic antidepressants, SNRI serotonin norepinephrine reuptake inhibitors