Driving performance and neurocognitive skills of long‐term users of sedating antidepressants

Nick N.J.J.M Van Der Sluiszen,Joke H Van Dijken,Karel A Brookhuis,Annemiek Vermeeren,Johannes G Ramaekers,Joris C Verster,Dick De Waard,Aurora J.A.E Van De Loo,Janet L Veldstra

doi:10.1002/hup.2762

Abstract

ObjectiveTo assess driving performance and neurocognitive skills of long‐term users of sedating antidepressants, in comparison to healthy controls.MethodsThirty‐eight long‐term (>6 months) users of amitriptyline (n = 13) and mirtazapine (n = 25) were compared to 65 healthy controls. Driving performance was assessed using a 1‐h standardised highway driving test in actual traffic, with road‐tracking error (standard deviation of lateral position [SDLP]) being the primary measure. Secondary measures included neurocognitive tasks related to driving. Performance differences between groups were compared to those of blood alcohol concentrations of 0.5 mg/ml to determine clinical relevance.ResultsCompared to controls, mean increase in SDLP of all antidepressant users was not significant, nor clinically relevant (+0.75 cm, 95% CI: −0.83 cm; +2.33 cm). However, users treated less than 3 years (n = 20) did show a significant and clinically relevant increase in SDLP (+2.05 cm). No significant effects were observed on neurocognitive tasks for any user group, although large individual differences were present. Most results from neurocognitive tests were inconclusive, while a few parameters confirmed non‐inferiority for users treated longer than 3 years.ConclusionThe impairing effects of antidepressant treatment on driving performance and neurocognition mitigate over time following long‐term use of 3 years.

Highlights

Despite the availability of non‐sedating antidepressant, older generation antidepressants are still frequently prescribed for the treatment of depression (Arroll et al, 2005; Brauer et al, 2013) and neuropathic pain (Nikolaus & Zeyfang, 2004; Gilron, Baron, & Jensen, 2015)
The current study compared the driving performance of long‐term users of sedating antidepressants to that of a normative control group consisting of healthy participants
The goal was to evaluate whether the classification of the investigated antidepressants in category category III medication (III) may be too conservative for drivers who use their medication for a prolonged time

Summary

| INTRODUCTION

Despite the availability of non‐sedating antidepressant, older generation antidepressants are still frequently prescribed for the treatment of depression (Arroll et al, 2005; Brauer et al, 2013) and neuropathic pain (Nikolaus & Zeyfang, 2004; Gilron, Baron, & Jensen, 2015). A study found that patients treated chronically with sedating antidepressants (clomipramine or imipramine) showed only minor impairment of psychomotor performance and memory as compared to healthy controls (Gorenstein, De Carvalho, Artes, Moreno, & Marcourakis, 2006) This raises the question whether long‐term use of sedating antidepressants is still associated with clinically relevant impairment of driving. Experimental studies have systematically assessed the clinical relevance of the effects of antidepressants on driving behaviour by means of comparison to alcohol, given its well documented dose dependent association with crash risk (Blomberg, Peck, Moskowitz, Burns, & Fiorentino, 2009; Borkenstein, Crowther, & Shumate, 1974) These studies focussed on driving performance after single and repeated doses of a range of antidepressants (Ramaekers, 2003). Data on long‐term benzodiazepine use and driving are published separately (van der Sluiszen et al, 2019)

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| RESULTS

Findings

| DISCUSSION