Antidepressants and road safety : a literature review and commentary.

This report presents a systematic review of driving performance and accident risk in relation to antidepressant drugs based on relevant .summary criteria for literature published after 1989. The evidence suggests that there is reliable evidence that older types of antidepressant drug such as TCA do affect psychomotor functions in a manner that can impair driving performance and increase accident risk. However, whereas there is some evidence that newer drugs such as SSRIs can also affect some functions, there is less evidence that driving performance is as impaired and very little research that considers the accident risk of these drugs. The recent observation that effects of SSRIs on performance are observed in repeated dose studies is cause for concern and highlights the need for independent research to corroborate the effects observed. In addition, far less research has examined RIMAs, NARIs and other novel antidepressants in both single and repeated dose studies. At present, those studies suggest that the effect of RIMAs on psychomotor performance is also less than for TCAs. It is too early to draw the conclusion that the newer generations of antidepressants do not exert effects on cognitive functions or have implications for driving performance and accident risk. Moreover, the validity of much research which has been conducted could be questioned, given that it has either used normal rather than clinical populations or has been confounded by indication. This research has not been able to identify 'tolerance' levels for antidepressants in terms of dose or duration of use for different clinical populations. There have also been some omissions in the reporting of this research, which limit the interpretation and replication of the results (for example, psychometrics of measures, nature of analytic method to detect drugs). On the basis of this review, it is concluded that more research is required to investigate the effects of new generation antidepressant drugs on driving performance and accident risk. In this regard, the report concludes with recommendations for future research. (Author/publisher)