Use of Antidepressants in Older Adults Linked to Driving Impairment on a Road Test

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

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

Each of these drug categories posed a higher risk of driving impairment on a road test compared to nonuse, which was scored marginal/fail, despite adjusting for age, sex, race, education, neighborhood deprivation, comorbidities, cognitive functioning, and visual acuity.

Previous literature has shown that older adults have a greater risk of being in an automotive crash compared to middle-aged drivers. This risk may be associated with an increased risk of frailty, but cognitive disorders are a major risk factor as well.

Although many medication classes may be linked to crashes, it is hard to discern whether the risk of crash is caused by medication adverse events (AEs), the medical condition itself, or other medications or comorbidities.

Investigators conducted a prospective cohort study to discern whether any potentially driver-impairing medications were associated with worse 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 aged 65 years and older from St. Louis, Missouri, or Illinois with a valid driver’s license and enrolled in the Knight Alzheimer’s Disease Research Center. Patients were cognitively healthy (baseline score of 0, according to the Clinical Dementia Rating, with a score of 0 at subsequent visits), and had provided neuropsychological, road tests, and self-reported medication data to include in the research.

After 5.70 years of follow-up, investigators found that any use of an antidepressant (adjusted hazard ratio [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 linked to worse risk of receiving a marginal or fail on the road test compared to participants who did not take one.

Patients taking a lipid-lowering agent were at less risk of failing their road test. Further, anticholinergics or antihistamines were not associated with worse driving performance in older adults.

Limitations of the study included its sample size, which is primarily non-Hispanic White with higher education. In addition, investigators did not include data on medication adherence, dose, frequency, or uptake method. Further, road tests were subjectively graded by an examiner and there was no analysis on the short- versus long-term effects of the medication.

The investigators concluded that more studies are needed to evaluate the risks of certain classes of medication on driving ability. For older patients who need to take any 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 traffic safety,” the study authors concluded.

Reference

Carr DB, Beyene K, Doherty J, et al. Medication and Road Test Performance Among Cognitively Healthy Older Adults. JAMA Netw Open. 2023;6(9):e2335651. DOI:10.1001/jamanetworkopen.2023.35651