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The Impact of Reboxetine and Mirtazapine on Driving Simulator Performance and Psychomotor Function in Depressed PatientsAlexander Brunnauer, Ph.D.; Gerd Laux, M.D.; Irmgard David, M.S.; Mirijam Fric, M.D.; Igor Hermisson, M.D.; and Hans-Jürgen Möller, M.D.Objective: The aim of the present study was to examine the influence of reboxetine and mirtazapine on psychomotor functions related to driving skills and on driving simulator performance in depressed inpatients. Method: Forty depressed inpatients diagnosed according to DSM-IV-TR criteria were randomly assigned to treatment with either reboxetine (N = 20) or mirtazapine (N = 20). To control for retest effects in psychomotor measures, a group of 10 healthy controls was examined on the same time schedule. Participants were tested once before pharmacologic treatment and twice after initiation of treatment (days 7 and 14) with computerized tests related to car-driving skills. Data were collected with the Act and React Testsystem ART-90 and the Wiener Testsystem, measuring visual perception, reactivity, stress tolerance, concentration, and vigilance. In addition, patients went through various risk simulations on a static driving simulator. Data were analyzed with nonparametric statistics and repeated-measures analysis of variance. The study was conducted from June 2004 through June 2006. Results: Before onset of treatment with antidepressants, about 65% of patients did not reach the threshold criterion according to the German guidelines for road and traffic safety. After 14 days of treatment with reboxetine or mirtazapine, patients improved in driving ability skills. Controlling for retest effects in psychomotor measures, data indicate that both patient groups significantly improved in tests measuring selective attention and reactivity (all p < .01). Furthermore, the frequency of accidents in the risk simulations markedly decreased in patients receiving mirtazapine and reboxetine (all p < .05). Statistically significant differences between treatment groups could not be shown. Conclusion: Our results indicate that partially remitted depressed inpatients treated with reboxetine or mirtazapine show a better performance on tasks related to driving skills than do untreated depressives. (J Clin Psychiatry 2008;69:1880-1886. Online Ahead of Print October 7, 2008.) Received Oct. 26, 2007; accepted March 11, 2008. From the Inn-Salzach-Hospital, Academic Hospital of Psychiatry, Psychotherapy, and Neurology, Wasserburg am Inn (Drs. Brunnauer, Laux, and Fric and Ms. David) and the Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich (Drs. Laux, Hermisson, and Möller), Germany. The study presented here has been sponsored by an unrestricted grant from Merz Pharmaceuticals GmbH. Data from this study were presented as a poster at the 20th European College of Neuropsychopharmacology Congress; October 13-17, 2007; Vienna, Austria. We thank Ms. Michaela Wende, Ms. Brigitte Peter, and Ms. Sarah Zwick, medical staff technicians in the Department of Neuropsychology, Inn-Salzach-Hospital, for their contributions to this project. Mss. Wende, Peter, and Zwick report no financial or other relationships relevant to the subject of this article. Dr. Möller has received grant/research support from, been a member of the speakers or advisory boards for, and received honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Eisai, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Organon, Pfizer, Sanofi-Aventis, Sepracor, Servier, and Wyeth and has also received grant/research support from Merck and Novartis. Drs. Brunnauer, Laux, Fric, and Hermisson and Ms. David report no additional financial or other relationships relevant to the subject of this article. Corresponding author and reprints: Alexander Brunnauer, Ph.D., Inn-Salzach-Klinikum, Department of Neuropsychology, D-83512 Wasserburg/Inn, Germany (e-mail: Alexander.Brunnauer@Inn-Salzach-Klinikum.de). |