Bramness Jørgen G, Skurtveit Svetlana, Neutel C Ineke, Mørland Jørg, Engeland Anders
Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, NO-0403 Oslo, Norway.
J Clin Psychiatry. 2008 Jul;69(7):1099-103. doi: 10.4088/jcp.v69n0709.
Experimental studies have shown that both depression and the use of antidepressants may impair the ability to drive a motor vehicle. Population-based studies have been inconclusive. Differences in results have been shown for cyclic, sedating antidepressants and newer, nonsedating antidepressants. The objective of the present study was to examine whether the use of antidepressants by drivers increased the risk of being involved in traffic accidents.
From April 2004 to September 2006, information on prescriptions, road accidents, and emigrations/deaths was obtained from 3 Norwegian population-based registries. Data on people between the ages 18-69 (N = 3.1 million) were linked. Exposure consisted of receiving prescriptions for any antidepressants. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of accidents during time exposed with the incidence over the time not exposed. Sedating antidepressants (tricyclic antidepressants, mianserin, and mirtazapine) were studied together as one group, and newer, nonsedating antidepressants (selective serotonin reuptake inhibitors, moclobemide, venlafaxine, and reboxetine) as another.
During the study period, 20,494 road accidents with personal injuries occurred, including 204 and 884 in which the driver was exposed to sedating antidepressants or newer, nonsedating antidepressants, respectively. The traffic accident risk increased slightly for drivers who had received prescriptions for sedating antidepressants (SIR = 1.4, 95% CI = 1.2 to 1.6) or nonsedating antidepressants (SIR = 1.6, 95% CI = 1.5 to 1.7). The SIR estimates were similar for male and female drivers and slightly higher for young drivers (18-34 years of age) using older sedative antidepressants. SIR estimates did not change substantially for different time periods after dispensing of the prescription, for concomitant use of other impairing drugs, or for new users.
There was a slightly increased risk of being involved in a traffic accident after having received a prescription for any antidepressants. In the present study, it was not possible to determine whether this increase was due to the antidepressant, the effect of the depression, or characteristics of the patients being prescribed these drugs.
实验研究表明，抑郁症及抗抑郁药的使用均可能损害驾驶机动车的能力。基于人群的研究尚无定论。对于三环类、具有镇静作用的抗抑郁药以及较新的、无镇静作用的抗抑郁药，研究结果存在差异。本研究的目的是检验驾驶员使用抗抑郁药是否会增加交通事故风险。
2004年4月至2006年9月，从挪威3个基于人群的登记处获取了处方、道路交通事故以及移民/死亡信息。将18至69岁人群（N = 310万）的数据进行关联。暴露因素为接受任何抗抑郁药处方。通过比较暴露期间的事故发生率与未暴露期间的事故发生率，计算标准化发病率比（SIR）。将具有镇静作用的抗抑郁药（三环类抗抑郁药、米安色林和米氮平）作为一组进行研究，将较新的、无镇静作用的抗抑郁药（选择性5-羟色胺再摄取抑制剂、吗氯贝胺、文拉法辛和瑞波西汀）作为另一组进行研究。
在研究期间，发生了20494起有人身伤害的道路交通事故，其中分别有204起和884起事故的驾驶员使用了具有镇静作用的抗抑郁药或较新的、无镇静作用的抗抑郁药。接受具有镇静作用的抗抑郁药处方的驾驶员（SIR = 1.4，95%可信区间 = 1.2至1.6）或无镇静作用的抗抑郁药处方的驾驶员（SIR = 1.6，95%可信区间 = 1.5至1.7），其交通事故风险略有增加。男性和女性驾驶员的SIR估计值相似，而使用较老的具有镇静作用的抗抑郁药的年轻驾驶员（18至34岁）的SIR估计值略高。处方配药后的不同时间段、同时使用其他损害性药物或新使用者的SIR估计值变化不大。
接受任何抗抑郁药处方后，交通事故风险略有增加。在本研究中，无法确定这种增加是由于抗抑郁药、抑郁症的影响还是开具这些药物的患者的特征所致。
