September 17, 2012 — Taking psychotropic drugs increases the risk of patients having a motor vehicle accident (MVA), new research suggests.
Chia-Ming Chang, MD, Lin-Kou and Chang Gung University, Taoyuan, Taiwan, and colleagues found that individuals taking antidepressants, benzodiazepines, and hypnotics had a significantly higher risk of having an MVA than did control participants who were not taking psychotropic medication.
In contrast, exposure to antipsychotics — both typical and atypical — was not associated with an increased risk for MVAs.
"It's long been known that psychotropic drugs impair cognitive and driving performance, but most studies have mainly examined the effect of benzodiazepines; few have examined the effect of antipsychotic drugs and/or antidepressants," Hui-Ju Tsai, MPH, PhD, National Health Research Institutes, Zhunan Town, Taiwan, toldMedscape Medical News.
"Moreover, most studies have been done in Caucasian populations, only a few in Asian populations. Our findings suggest clinicians or healthcare providers carefully evaluate the condition of patients before prescribing psychotropic drugs, and if they need to take them routinely, inform their patients about the potential side effect of these agents, especially the first time of prescription."
The study was published September 12 in the British Journal of Clinical Pharmacology.
Significantly Increased Risk
For this study, investigators analyzed a subset of data from the Longitudinal Health Insurance Database from 2000 to 2009. Prescription data were also recorded in that database.
The comparison group included individuals who did not have any outpatient record for MVA-associated visits.
Some 5183 cases with a documented MVA and 31,093 control participants were included in the analysis.
The drugs analyzed included both typical and atypical antipsychotics; various classes of antidepressants; short- and long-acting benzodiazepines, including hypnotics and anxiolytics; and a fourth group investigators called the "Z" drugs, which included zolpidem, zolpiclone, and zaleplon, also categorized as hypnotics.
After adjusting for confounding variables, "a significantly increasing risk of MVAs was observed among subjects taking antidepressant within one month before MVAs occurred at an adjusted odds ratio (OR) =1.73," investigators note.
"Similar patterns" were observed for persons taking an antidepressant within 1 week and 1 day before the MVA occurred, they added, with no difference in MVA risk seen within the different antidepressant drug classes.
A significantly increased risk for MVAs was also found among persons taking benzodiazepines within 1 month, 1 week, and 1 day prior to the accident, again with no difference in accident risk seen between the short- and long-acting drugs.
As for the "Z" drugs, an increased risk for MVAs was also seen in persons after exposure within 1 month, 1 week, and 1 day prior to the MVA occurring.
Adjusted ORs of MVA Risk
| Antidepressants | Benzodiazepines | Z Drugs | |
| Within 1 month | 1.73 | 1.56 | 1.42 |
| Within 1 week | 1.71 | 1.64 | 1.37 |
| Within 1 day | 1.70 | 1.62 | 1.34 |
"Clinicians or healthcare providers should regularly monitor the status of patients taking psychotropic drugs and adjust their prescription accordingly," said Dr. Tsai. "And if they can prescribe these agents before bed — although this would depend on the condition of patients — it may prevent the occurrence of MVAs to a certain degree."
Other Variables at Play?
Thomas Wise, MD, from George Washington University School of Medicine, Washington, DC, told Medscape Medical News that there may be other variables such as irritability in depression that are contributing to the propensity of patients on antidepressants to have a higher risk for MVAs rather than the medication itself.
He also pointed out that this study was in a strictly Asian population, so their findings may — or may not — apply to people of different ethnic origins.
Nevertheless, he felt it was "quite a good study."
"It also alerts us to fact that we should be making sure we warn our patients if they're on antidepressants or any of the hypnotics that the drugs may modify their ability to drive. It doesn't mean they should stop driving. We just need to warn them to watch out for problems if they're driving."
The study was funded by the Department of Health and National Health Research Institutes. The study authors and Dr. Wise have disclosed no relevant financial relationships.
Br J Clin Pharmacol. Published online September 12, 2012. Abstract
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