Antidepressants and Driving Ability: Results From a Clinical Study
J Clin Psychiatry 2006;67(11):1776-1781
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Psychomotor disturbances can
frequently be found in depressed patients and may have an important influence on the ability
to drive. Additionally, effects of sedation, as
seen with some antidepressants, probably impair
driving performance. The present study was
designed to evaluate the effects of antidepressant
monotherapy on psychomotor functions related to
car-driving skills in depressive patients in a
routine clinical setting.
Method: Inpatients (N = 100) who met
the ICD-10 and DSM-IV criteria for major
depressive disorder were tested under steady-state
plasma level conditions prior to being discharged to
outpatient treatment. The study ran from January 2004 through March 2005. All patients
participated voluntarily and gave informed consent.
According to the German guidelines for road and traffic safety, data were collected with the
computerized Act & React Testsystem ART-90 and
the Wiener Testsystem, measuring visual
perception, reaction time, selective attention, vigilance,
and stress tolerance. Psychopathologic symptoms were rated with the Hamilton Rating Scale
Results: Before discharge to outpatient
treatment, 24% of the patients tested were without clinically relevant psychomotor disturbances.
In 60% of the cases, mild to moderate impairments could be seen, and about 16% of the patients
were considered as severely impaired in
psychomotor functions related to car-driving abilities.
Data show that patients treated with selective
serotonin reuptake inhibitors (SSRIs) or the
noradrenergic and specific serotonergic antidepressant
(NaSSA) mirtazapine had an altogether better test
performance in comparison with patients receiving
tricyclic antidepressants (TCAs). Differences were most pronounced in measures of reactivity,
stress tolerance, and selective attention.
Statistically significant differences between patients
treated with TCAs or the serotonin-norepinephrine
reuptake inhibitor (SNRI) venlafaxine could not be found. Among the newer antidepressants there
is an advantage for patients treated with mirtazapine, especially in tasks with high
multi-channel perception and output demands.
Conclusion: About 16% of depressive
patients discharged from hospital to outpatient
treatment must be considered unfit to drive. In 60% of
the cases, patients performed at a questionable
level of fitness for driving, and it seems justified
to counsel patients individually, taking into
account compensational factors. Data point to an
advantage for patients treated with SSRIs or
mirtazapine when compared with TCAs or
venlafaxine. However, causal relationships cannot be
drawn from our data.