Antidepressants and Driver Impairment: Empirical Evidence From a Standard On-the-Road Test. [CME]
J Clin Psychiatry 2003;64:20-29
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background and Method: The current review
summarizes the major results from all published studies from 1983
to 2000 (9 double-blind, crossover, placebo-controlled studies in
healthy volunteers and 1 double-blind, baseline-controlled study
in patients) that have determined the effects of antidepressants
on actual driving performance using a standard test. That test
measures driving impairment from vehicular "weaving"
(i.e., standard deviation of lateral position [SDLP]) during 1
hour of on-the-road driving in normal traffic.
Results: Changes in SDLP after acute doses of
sedating antidepressants (i.e., amitriptyline, imipramine,
doxepin, and mianserin) were comparable to those seen in drivers
conducting the same test with a blood alcohol concentration of
0.8 mg/mL or more. Driving performance of subjects returned to
placebo levels after 1 week of treatment, except after treatment
with mianserin, for which the impairing effect lasted unabated
over treatment. Nocturnal doses of sedating antidepressants
(i.e., dothiepin, mianserin, and mirtazapine), however, did not
produce residual driving impairment when measured the next day.
Nonsedating antidepressants (i.e., moclobemide, fluoxetine,
paroxetine, venlafaxine, and nefazodone) generally did not affect
SDLP. However, SDLP rose to unacceptable levels after
administration of combinations of nonsedating antidepressants and
benzodiazepines with incompatible pharmacokinetic profiles.
Correlational analyses demonstrated that conventional tests of
psychomotor performance or self-ratings of side effects did not
strongly predict antidepressant effects on SDLP. Regression
analysis revealed a strong linear relation between antidepressant
effects in the standard driving test and the number of patients
reporting somnolence in clinical trials with the same
Conclusion: Application of actual driving tests
remains essential to conclusively defining the potential hazard
of drugs for driving.