Table 2.
Antidepressants and crash riska
| 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) |
a SIR standardized incidence ratios, CI confidence interval, OR odds ratio, SSRI selective serotonin reuptake inhibitor, TCA tricyclic antidepressants, SNRI serotonin norepinephrine reuptake inhibitors