Skip to main content

Advertisement

SpringerLink
Log in

The association between antidepressant use and deaths from road traffic accidents: a case-crossover study

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Antidepressants are some of the most commonly used psychiatric medications, but little information is available about the effects of antidepressant treatment on the risk of traffic accidents across classes of antidepressants or associated with each substance individually. To investigate the relationship between exposure to antidepressants and risk of fatality in road traffic accidents.

Methods

We used a Korean national road traffic authority database linked with a national health insurance database between January 1, 2010 and December 31, 2014 and applied a case-crossover design. The study subjects were drivers in South Korea who died from traffic accidents and who had prescriptions for antidepressants within 1 year prior to the date of the accident. We compared the status of prescription for antidepressants with the hazard period and four matched control periods using conditional logistic regression, adjusting for other drug use. The trends of antidepressant utilization were described in terms of the number of prescriptions. A case–case-time-control design was applied to drugs with an increasing trend in use and a significant case-crossover odds ratio (OR).

Results

A total of 1250 antidepressant-using drivers were included, and an increased risk was observed during the 30-day hazard period (adjusted OR 1.30; 95% CI 1.03–1.63). Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) showed significant risks, but tricyclic antidepressants did not. However, the associations of all antidepressants, SSRIs, SNRIs, escitalopram, and duloxetine did not remain significant after adjusting for trends in utilization. Paroxetine and milnacipran were associated with increased risks, with no obvious increase in their utilization, but the possibility of confounding by indication could have affected the results for milnacipran.

Conclusion

Considering the trends of antidepressant prescription and utilization, the use of paroxetine increased the risk of fatal traffic accidents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51(1):8–19

    Article  CAS  PubMed  Google Scholar 

  2. Ustun TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJ (2004) Global burden of depressive disorders in the year 2000. Br J Psychiatry 184:386–392

    Article  CAS  PubMed  Google Scholar 

  3. Wells KB, Sherbourne CD (1999) Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices. Arch Gen Psychiatry 56(10):897–904

    Article  CAS  PubMed  Google Scholar 

  4. Hirschfeld RM, Montgomery SA, Keller MB, Kasper S, Schatzberg AF, Moller HJ, Healy D, Baldwin D, Humble M, Versiani M, Montenegro R, Bourgeois M (2000) Social functioning in depression: a review. J Clin Psychiatry 61(4):268–275

    Article  CAS  PubMed  Google Scholar 

  5. Won E, Park SC, Han KM, Sung SH, Lee HY, Paik JW, Jeon HJ, Lee MS, Shim SH, Ko YH, Lee KJ, Han C, Ham BJ, Choi J, Hwang TY, Oh KS, Hahn SW, Park YC, Lee MS, Clinical Research Center for D (2014) Evidence-based, pharmacological treatment guideline for depression in Korea, revised edition. J Korean Med Sci 29(4):468–484. https://doi.org/10.3346/jkms.2014.29.4.468

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Verster JC, Ramaekers JG (2009) Antidepressants and traffic safety. In: Verster JC, Pandi-Perumal SR, Ramaekers JG, de Gier JJ (eds) Drugs, driving and traffic safety. Birkaeuser Verlag AG, Basel, 307–313

    Chapter  Google Scholar 

  7. Sansone RA, Sansone LA (2009) Driving on antidepressants: cruising for a crash? Psychiatry (Edgmont) 6(9):13–16

    Google Scholar 

  8. Dassanayake T, Michie P, Carter G, Jones A (2011) Effects of benzodiazepines, antidepressants and opioids on driving: a systematic review and meta-analysis of epidemiological and experimental evidence. Drug Saf 34(2):125–156. https://doi.org/10.2165/11539050-000000000-00000

    Article  CAS  PubMed  Google Scholar 

  9. Ray WA, Fought RL, Decker MD (1992) Psychoactive-drugs and the risk of injurious motor-vehicle crashes in elderly drivers. Am J Epidemiol 136(7):873–883

    Article  CAS  PubMed  Google Scholar 

  10. Leveille SG, Buchner DM, Koepsell TD, Mccloskey LW, Wolf ME, Wagner EH (1994) Psychoactive medications and injurious motor-vehicle collisions involving older drivers. Epidemiology 5(6):591–598. https://doi.org/10.1097/00001648-199411000-00006

    Article  CAS  PubMed  Google Scholar 

  11. Rapoport MJ, Herrmann N, Molnar F, Rochon PA, Juurlink DN, Zagorski B, Seitz D, Morris JC, Redelmeier DA (2008) Psychotropic medications and motor vehicle collisions in patients with dementia. J Am Geriatr Soc 56(10):1968–1970. https://doi.org/10.1111/j.1532-5415.2008.01903.x

    Article  PubMed  Google Scholar 

  12. Bramness JG, Skurtveit S, Neutel CI, Morland J, Engeland A (2008) Minor increase in risk of road traffic accidents after prescriptions of antidepressants: a study of population registry data in Norway. J Clin Psychiatry 69(7):1099–1103

    Article  PubMed  Google Scholar 

  13. Rapoport MJ, Zagorski B, Seitz D, Herrmann N, Molnar F, Redelmeier DA (2011) At-fault motor vehicle crash risk in elderly patients treated with antidepressants. Am J Geriatr Psychiatry 19(12):998–1006. https://doi.org/10.1097/JGP.0b013e31820d93f9

    Article  PubMed  Google Scholar 

  14. Barbone F, McMahon AD, Davey PG, Morris AD, Reid IC, McDevitt DG, MacDonald TM (1998) Association of road-traffic accidents with benzodiazepine use. Lancet 352(9137):1331–1336

    Article  CAS  PubMed  Google Scholar 

  15. Ravera S, van Rein N, de Gier JJ, de Jong-van den Berg LTW (2011) Road traffic accidents and psychotropic medication use in the Netherlands: a case-control study. Br J Clin Pharmacol 72(3):505–513. https://doi.org/10.1111/j.1365-2125.2011.03994.x

    Article  PubMed  PubMed Central  Google Scholar 

  16. Orriols L, Wilchesky M, Lagarde E, Suissa S (2013) Prescription of antidepressants and the risk of road traffic crash in the elderly: a case-crossover study. Br J Clin Pharmacol 76(5):810–815. https://doi.org/10.1111/bcp.12090

    Article  PubMed  PubMed Central  Google Scholar 

  17. Schneeweiss S, Sturmer T, Maclure M (1997) Case-crossover and case-time-control designs as alternatives in pharmacoepidemiologic research. Pharmacoepidemiol Drug Saf 6(Suppl 3):S51–S59

    Article  PubMed  Google Scholar 

  18. Cheol Seong S, Kim YY, Khang YH, Heon Park J, Kang HJ, Lee H, Do CH, Song JS, Hyon Bang J, Ha S, Lee EJ, Ae Shin S (2017) Data resource profile: the National Health Information Database of the National Health Insurance Service in South Korea. Int J Epidemiol 46(3):799–800. https://doi.org/10.1093/ije/dyw253

    Article  PubMed  Google Scholar 

  19. Jung SY, Hwang B, Yang BR, Kim YJ, Lee J (2017) Risk of motor vehicle collisions associated with medical conditions and medications: rationale and study protocol. Inj Prev 23(5):356. https://doi.org/10.1136/injuryprev-2016-042177

    Article  PubMed  Google Scholar 

  20. Maclure M (1991) The case-crossover design—a method for studying transient effects on the risk of acute events. Am J Epidemiol 133(2):144–153

    Article  CAS  PubMed  Google Scholar 

  21. Maclure M, Mittleman MA (2000) Should we use a case-crossover design? Annu Rev Publ Health 21:193–221. https://doi.org/10.1146/annurev.publhealth.21.1.193

    Article  CAS  Google Scholar 

  22. Hooper TI, DeBakey SF, Pearse L, Pratt S, Hoffman KJ (2010) The use of electronic pharmacy data to investigate prescribed medications and fatal motor vehicle crashes in a military population, 2002–2006. Accid Anal Prev 42(1):261–268. https://doi.org/10.1016/j.aap.2009.07.024

    Article  PubMed  Google Scholar 

  23. Bjorkenstam C, Moller J, Ringback G, Salmi P, Hallqvist J, Ljung R (2013) An association between initiation of selective serotonin reuptake inhibitors and suicide—a nationwide register-based case-crossover study. Plos One 8(9):e73973. https://doi.org/10.1371/journal.pone.0073973

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Robertson MD, Drummer OH (1994) Responsibility analysis: a methodology to study the effects of drugs in driving. Accid Anal Prev 26(2):243–247

    Article  CAS  PubMed  Google Scholar 

  25. Wang SV, Linkletter C, Maclure M, Dore DD, Mor V, Buka S, Wellenius G (2011) Future cases as present controls: methods to adjust for exposure-time trends. Pharmacoepidemiol Drug Saf 20:S148–S148

    Article  Google Scholar 

  26. Orriols L, Queinec R, Philip P, Gadegbeku B, Delorme B, Moore N, Suissa S, Lagarde E, Group CR (2012) Risk of injurious road traffic crash after prescription of antidepressants. J Clin Psychiatry 73(8):1088–1094. https://doi.org/10.4088/JCP.11m07624

    Article  PubMed  Google Scholar 

  27. Fournier JP, Wilchesky M, Patenaude V, Suissa S (2015) Concurrent use of benzodiazepines and antidepressants and the risk of motor vehicle accident in older drivers: a nested case-control study. Neurol Ther 4(1):39–51. https://doi.org/10.1007/s40120-015-0026-0

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wingen M, Ramaekers JG, Schmitt JA (2006) Driving impairment in depressed patients receiving long-term antidepressant treatment. Psychopharmacology 188(1):84–91. https://doi.org/10.1007/s00213-006-0471-7

    Article  CAS  PubMed  Google Scholar 

  29. Wijlaars LP, Nazareth I, Whitaker HJ, Evans SJ, Petersen I (2013) Suicide-related events in young people following prescription of SSRIs and other antidepressants: a self-controlled case series analysis. BMJ Open 3(9):e003247. https://doi.org/10.1136/bmjopen-2013-003247

    Article  PubMed  PubMed Central  Google Scholar 

  30. Campagne DM (2005) Venlafaxine and serious withdrawal symptoms: warning to drivers. Medscape Gen Med 7(3):22

    Google Scholar 

  31. By the American Geriatrics Society Beers Criteria Update Expert P (2015) American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63(11):2227–2246. https://doi.org/10.1111/jgs.13702

    Article  Google Scholar 

  32. Laroche ML, Charmes JP, Merle L (2007) Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 63(8):725–731. https://doi.org/10.1007/s00228-007-0324-2

    Article  PubMed  Google Scholar 

  33. Berger A, Dukes EM, Edelsberg J, Stacey BR, Oster G (2006) Use of tricyclic antidepressants in older patients with painful neuropathies. Eur J Clin Pharmacol 62(9):757–764. https://doi.org/10.1007/s00228-006-0161-8

    Article  CAS  PubMed  Google Scholar 

  34. Schmitt JA, Ramaekers JG, Kruizinga MJ, van Boxtel MP, Vuurman EF, Riedel WJ (2002) Additional dopamine reuptake inhibition attenuates vigilance impairment induced by serotonin reuptake inhibition in man. J Psychopharmacol 16(3):207–214. https://doi.org/10.1177/026988110201600303

    Article  CAS  PubMed  Google Scholar 

  35. Ridout F, Meadows R, Johnsen S, Hindmarch I (2003) A placebo controlled investigation into the effects of paroxetine and mirtazapine on measures related to car driving performance. Hum Psychopharmacol 18(4):261–269. https://doi.org/10.1002/hup.494

    Article  CAS  PubMed  Google Scholar 

  36. Iwamoto K, Takahashi M, Nakamura Y, Kawamura Y, Ishihara R, Uchiyama Y, Ebe K, Noda A, Noda Y, Yoshida K, Iidaka T, Ozaki N (2008) 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 23(5):399–407. https://doi.org/10.1002/hup.939

    Article  CAS  PubMed  Google Scholar 

  37. Hindmarch I, Kimber S, Cockle SM (2000) Abrupt and brief discontinuation of antidepressant treatment: effects on cognitive function and psychomotor performance. Int Clin Psychopharmacol 15(6):305–318

    Article  CAS  PubMed  Google Scholar 

  38. Hindmarch I, Rigney U, Stanley N, Briley M (2000) Pharmacodynamics of milnacipran in young and elderly volunteers. Br J Clin Pharmacol 49(2):118–125

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Richet F, Marais J, Serre C, Panconi E (2004) Effects of milnacipran on driving vigilance. Int J Psychiatry Clin Pract 8(2):109–115. https://doi.org/10.1080/13651500410005432

    Article  CAS  PubMed  Google Scholar 

  40. Poirier MF, Galinowski A, Amado I, Longevialle R, Bourdel MC, Tournoux A, Serre C, Loo H (2004) Double-blind comparative study of the action of repeated administration of milnacipran versus placebo on cognitive functions in healthy volunteers. Hum Psychopharmacol 19(1):1–7. https://doi.org/10.1002/hup.557

    Article  CAS  PubMed  Google Scholar 

  41. Korea Institute of Drug Safety and Risk Management (2015) Instruction of changing the label according to the results of re-examination study. https://www.drugsafe.or.kr/iwt/ds/ko/bbs/EgovBbs.do?bbsId=BBSMSTR_000000000051&nttId=1521. Accessed 14 Dec 2018

  42. Korean Society for Affective Disorders and Korean College of Neuropsychopharmacology, Korean Medication Algorithm Project for Depressive Disorder (2012) http://www.theksad.or.kr/data/etc/beflmp19FIOW.pdf. Accessed 14 Dec 2018

  43. Wu CS, Wu HT, Tsai YT, Huang YW, Tsai HJ (2017) Use of antidepressants and risk of hospitalization for acute myocardial infarction: a nationwide case-crossover study. J Psychiatr Res 94:7–14. https://doi.org/10.1016/j.jpsychires.2017.06.001

    Article  PubMed  Google Scholar 

  44. Charlton J, Koppel S, Odell M, Devlin A, Langford J, O’Hare M, Kopinathan C, Andrea D, Smith G, Khodr B (2010) Influence of chronic illness on crash involvement of motor vehicle drivers. Monash University Accident Research Center (MUARC), Clayton

    Google Scholar 

Download references

Acknowledgements

The research was promoted as part of the ‘Technology Development for Behavior Improvement and Violation Control of High Risk Drivers’ program that was carried out by the Ministry of Land, Infrastructure and Transport in Korea (Grant Number 14TLRP-B085437-01). The funding body did not play a role in the study design, writing of the manuscript, or in the decision to submit the manuscript for publication.

Author information

Author notes

  1. Bo Ram Yang and Kyoung-eun Kwon contributed equally to this article as co-first authors.

Authors and Affiliations

  1. Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea

    Bo Ram Yang & Mi-Sook Kim

  2. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    Kyoung-eun Kwon, Mi-Sook Kim & Byung-Joo Park

  3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea

    Ye-Jee Kim

  4. Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea

    Nam-Kyong Choi

  5. College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea

    Sun-Young Jung

  6. School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea

    Ju-Young Shin

  7. Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea

    Yong Min Ahn

  8. Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    Yong Min Ahn

  9. School of Medicine, Inha University, Incheon, Republic of Korea

    Joongyub Lee

  10. Department of Prevention and Management, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, Republic of Korea

    Joongyub Lee

Authors
  1. Bo Ram Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyoung-eun Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ye-Jee Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nam-Kyong Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mi-Sook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sun-Young Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ju-Young Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yong Min Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Byung-Joo Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Joongyub Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joongyub Lee.

Ethics declarations

Conflict of interest

The authors declared no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 15 KB)

Supplementary material 2 (DOCX 87 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, B.R., Kwon, Ke., Kim, YJ. et al. The association between antidepressant use and deaths from road traffic accidents: a case-crossover study. Soc Psychiatry Psychiatr Epidemiol 54, 485–495 (2019). https://doi.org/10.1007/s00127-018-1637-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-018-1637-4

Keywords

Search

Navigation