Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Soc Psychiatry Psychiatr Epidemiol. 2019 Apr;54(4):485-495. doi: 10.1007/s00127-018-1637-4. Epub 2018 Nov 24.
Antidepressants are some of the most commonly used psychiatric medications, but little information is available about the effects of antidepressant treatment on the risk of traffic accidents across classes of antidepressants or associated with each substance individually. To investigate the relationship between exposure to antidepressants and risk of fatality in road traffic accidents.
We used a Korean national road traffic authority database linked with a national health insurance database between January 1, 2010 and December 31, 2014 and applied a case-crossover design. The study subjects were drivers in South Korea who died from traffic accidents and who had prescriptions for antidepressants within 1 year prior to the date of the accident. We compared the status of prescription for antidepressants with the hazard period and four matched control periods using conditional logistic regression, adjusting for other drug use. The trends of antidepressant utilization were described in terms of the number of prescriptions. A case-case-time-control design was applied to drugs with an increasing trend in use and a significant case-crossover odds ratio (OR).
A total of 1250 antidepressant-using drivers were included, and an increased risk was observed during the 30-day hazard period (adjusted OR 1.30; 95% CI 1.03-1.63). Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) showed significant risks, but tricyclic antidepressants did not. However, the associations of all antidepressants, SSRIs, SNRIs, escitalopram, and duloxetine did not remain significant after adjusting for trends in utilization. Paroxetine and milnacipran were associated with increased risks, with no obvious increase in their utilization, but the possibility of confounding by indication could have affected the results for milnacipran.
Considering the trends of antidepressant prescription and utilization, the use of paroxetine increased the risk of fatal traffic accidents.
抗抑郁药是最常用的精神科药物之一，但关于抗抑郁治疗对各类抗抑郁药或与每种药物相关的交通事故风险的影响的信息很少。本研究旨在调查暴露于抗抑郁药与道路交通事故死亡风险之间的关系。
我们使用了韩国国家道路交通管理局数据库与国家健康保险数据库的链接，该数据库涵盖了 2010 年 1 月 1 日至 2014 年 12 月 31 日期间的数据，并应用了病例交叉设计。研究对象为在韩国死于交通事故的驾驶员，他们在事故发生前 1 年内有抗抑郁药处方。我们使用条件逻辑回归，在调整其他药物使用的情况下，将抗抑郁药的处方状态与危险期和四个匹配的对照期进行比较。我们用处方数量描述了抗抑郁药利用的趋势。对于使用呈上升趋势且病例交叉比值比（OR）有显著意义的药物，我们应用病例-病例-时间-对照设计。
共纳入 1250 名使用抗抑郁药的驾驶员，在 30 天的危险期中观察到风险增加（调整后的 OR 1.30；95%CI 1.03-1.63）。选择性 5-羟色胺再摄取抑制剂（SSRIs）和 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）显示出显著的风险，但三环类抗抑郁药没有。然而，在调整利用趋势后，所有抗抑郁药、SSRIs、SNRIs、艾司西酞普兰和度洛西汀的相关性均不再显著。帕罗西汀和米那普仑与风险增加相关，其利用量没有明显增加，但米那普仑的结果可能受到指示性混淆的影响。
考虑到抗抑郁药处方和利用的趋势，帕罗西汀的使用增加了致命交通事故的风险。
