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

Abstract

This review provides an update of experimental and clinical studies on the effects of antidepressants on driving performance. A systematic literature search on the PubMed database (1980-2016) was performed. 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. Much more patient studies are needed to elucidate a crucial question: from which antidepressant treatment do patients benefit most with respect to driving performance?

Trends in Antidepressants Use in Spain between 2015 and 2018: Analyses from a Population-Based Registry Study with Reference to Driving

“…On the other hand, the conclusions obtained by Ravera et al [10] and Brunnauer et al [8,14] when analyzing different experimental studies indicate that SSRIs do not present a high risk for driving vehicles, unless treatment is at high doses or there is concomitant consumption with other DIMs.…”

“…Currently, SSRIs have practically replaced TCAs due to their greater tolerability and safety [13]. Studies report on Odds Ratios (OR) from 1.10 to 3.10 for the risk of a traffic accident when being under antidepressant treatment [14], which highlights the risk of increasing doses of TCAs [15][16][17][18] as a clear relation involving exclusively the use of TCAs that is not confirmed [19]. On the other hand, among studies that assessed the influence of non-sedative antidepressants, such as SSRIs and venlafaxine, a slight or no increase in the risk of traffic accidents was found [18,19].…”

Use of psychotropic medication and risk of road traffic crashes: a registry-based case–control study in Denmark, 1996–2018

“…A meta-analysis by Elvik suggested a 35% increased risk of traffic crashes involving personal injury from antidepressant use (Elvik 2013 ). Recent clinical studies have shown that modern antidepressants improve or at least stabilise the driving skills of persons with depression (Brunnauer et al 2021 ; Brunnauer and Laux 2013 , 2017 ).…”

Neuropsychological exponents for the driving ability in remitted bipolar patients

“…On the other hand, Miyata et al ( 2018 ) found that partly remitted depressive patients treated with antidepressants (monotherapy and combination) do not differ from healthy controls concerning the performance of Wisconsin Card sorting test, TMT, and Continuous Performance Test. Brunnauer and Laux ( 2017 ) found, based on a systematic literature review, that SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) venlafaxine and milnacipran did not affect driving ability.…”