The importance of accidents in evaluating the cost of SSRIs: a review.

Economic studies attempting to justify the increased cost of new antidepressants such as the SSRIs are often difficult to interpret, marginal benefits hinging on minute differences in assumptions and interpretation. Studies to date have focused largely upon the costs of treatment failure, which in turn relates to compliance rates. A missing factor is the cost of accidents, especially serious road traffic accidents. Most tricyclic antidepressants seriously impair driving performance, even more so than alcohol or benzodiazepines, whilst SSRIs do not. With moves towards maintenance and continuation therapy for depression, patients on tricyclics remain at long-term risk for such accidents. Cost savings from reducing the rate of accidents could more than pay for the increased costs of SSRIs.