Antidepressant Use Among Older Adults Linked to Driving Impairments on Road Test

Antidepressants may inhibit older adults’ ability to drive, according to a new study published in JAMA Open Network. The cohort study found that serotonin/norepinephrine reuptake inhibitors (SSRIs and SNRIs, respectively), sedatives and hypnotics, as well as nonsteroidal anti-inflammatory drugs (NSAIDs) and drugs based on acetaminophen increased the risk of failing a road test over time in adults aged 65 and older.

These results are consistent with previous studies published in the literature that found associations with motor vehicle accidents and antidepressants, sedatives and hypnotics, the study authors wrote in the article.

Each of these drug categories had a higher risk of driving impairment on a road test compared to non-use, which was rated as marginal/fail, despite adjusting for age , gender, race, education, neighborhood deprivation, comorbidities, cognitive functioning, and visual acuity.

Previous studies have shown that older people are at greater risk of being involved in a car accident than middle-aged drivers. This risk may be associated with an increased risk of frailty, but cognitive impairment is also a major risk factor.

Although many classes of drugs may be linked to accidents, it is difficult to determine whether accident risk is caused by drug-related adverse events (AEs), by the condition itself, or by other medications or comorbidities.

Investigators conducted a prospective cohort study to determine whether potentially impairing driver medications were associated with poorer road test performance over time. These medications include antipsychotics, antidepressants, benzodiazepines, sedatives and hypnotics, opioids, anticholinergics, antihistamines, NSAIDs, and acetaminophen.

The study included 198 adults ages 65 and older from St. Louis, Missouri or Illinois who held a valid driver’s license and were enrolled in the Knight Alzheimers Disease Research Center. Patients were cognitively healthy (baseline score of 0, according to the Clinical Dementia Assessment, with a score of 0 at subsequent visits) and had provided neuropsychological, road test, and self-reported medication data to be included in the research.

After 5.70 years of follow-up, investigators found that any use of an antidepressant (adjusted relative risk) [aHR], 2.68; 95% CI, 1.69-4.71), including SSRIs and SNRIs (aHR, 2.68; 95% CI, 1.54-4.64), sedatives or hypnotics (aHR, 2.70; 95% CI, 1.40-5.19) or NSAIDs (aHR, 2.72). ; 95% CI, 1.31-5.63) was associated with a higher risk of obtaining a marginal exam or failing the practical exam compared to participants who did not take one.

Patients taking a lipid-lowering agent were less likely to fail their practical exam. Additionally, anticholinergics or antihistamines were not associated with poorer driving performance in older adults.

Limitations of the study included its sample size, which is primarily comprised of college-educated, non-Hispanic Whites. Additionally, investigators did not include data on treatment compliance, dose, frequency, or method of intake. Additionally, the practical tests were subjectively evaluated by an examiner and there was no analysis of the short- and long-term effects of the drug.

The investigators concluded that further studies were needed to assess the risks of certain classes of drugs on driving ability. For elderly patients who must take one of these medications, clinicians might consider following prescribing guidelines such as the Beers Criteria, which could limit adverse effects in older adults and potentially benefit road safety, concluded the study authors.

Reference

Carr DB, Beyene K, Doherty J et al. Performance of medications and road tests in cognitively healthy older adults. JAMA Netw open. 2023;6(9):e2335651. DOI:10.1001/jamanetworkopen.2023.35651