Driving Under the Influence of Antidepressants: A Systematic Review and Update of the Evidence of Experimental and Controlled Clinical Studies

2017 ◽  
Vol 50 (05) ◽  
pp. 173-181 ◽  
Author(s):  
Alexander Brunnauer ◽  
Gerd Laux
Keyword(s):  
Clinical Studies ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Driving Performance ◽  
Driving Under The Influence ◽  
Driving Ability ◽  
Driving Skills ◽  
Pubmed Database ◽  
Repeated Dosing ◽  
Patient Studies

Abstract Introduction This review provides an update of experimental and clinical studies on the effects of antidepressants on driving performance. Methods A systematic literature search on the PubMed database (1980–2016) was performed. Results Twenty-eight studies could be included in this review, whereas only 5 studies investigated driving performance under antidepressants in patients. Most tri- and tetracyclics have acute deleterious effects on driving performance that, except for mianserin, attenuate after subchronic use. Selective serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitor’s venlafaxine and milnacipran did not affect driving ability. Trazodone appears to have dose-related acute effects on driving skills. Acute use of mirtazapine does produce impairments that diminish when given as a nocturnal dose and cannot be seen in healthy subjects when initially given as a low dose or after repeated dosing. Additive effects with alcohol were most pronounced with sedating antidepressants. Most patients definitely benefit from treatment with newer antidepressants with respect to driving skills. Discussion Much more patient studies are needed to elucidate a crucial question: from which antidepressant treatment do patients benefit most with respect to driving performance?

Antidepressants and Driving Ability

2017 ◽  
Vol 41 (S1) ◽  
pp. S50-S51 ◽  
Author(s):  
J. Ramaekers
Keyword(s):  
Antidepressant Treatment ◽  
Treated Group ◽  
Driving Performance ◽  
Driving Ability ◽  
Healthy Controls ◽  
Depressed Patients ◽  
Driving Impairment ◽  
Severity Of Depression ◽  
On The Road

Depression is a mental disorder that is likely to affect daily functions, including driving ability. However, driving performance of depressed patients remains poorly investigated. We will present 2 studies designed to assess driving performance of patients receiving long-term antidepressant treatment. The first study compared driving performance of untreated depressed patients, depressed patients receiving SSRI or SNRI treatment for 6–52 weeks and matched healthy controls. The second study compared driving performance of long-term users of sedative antidepressants to that of matched healthy controls. A standardized on-the-road driving test was used to assess standard deviation of lateral position (SDLP), a measure of weaving. In the first study, mean SDLP of untreated and treated patients were significantly higher as compared to SDLP of matched controls. Driving impairment in the treated group was significantly less as compared to the untreated group. SDLP was positively correlated to severity of depression across both groups of patients. In the second study, SDLP of patients receiving sedative antidepressants (e.g. mirtazapine) during 0,5–3 yrs was significantly higher as compared to matched controls. Driving performance of patients receiving sedative antidepressants for more than 3 yrs did not differ from matched controls. Severity of depression in these patients groups was low. It is concluded that symptoms of depression are a major cause of driving impairment. Reductions in severity of depression through antidepressant treatment reduce severity of driving impairment. Sedative antidepressants such as mirtazapine however can still induce driving impairment in patients with remission for up to 3 yrs of use.Disclosure of interestThe work presented was funded by the Dutch ministry of Infrastructure and transport and the European Committee.

scholarly journals Pathophysiological basis of cardiovascular disease and depression: a chicken-and-egg dilemma

2010 ◽  
Vol 32 (2) ◽  
pp. 181-191 ◽  
Author(s):  
Gilberto Paz-Filho ◽  
Julio Licinio ◽  
Ma-Li Wong
Keyword(s):  
Cardiovascular Disease ◽  
Serotonin Reuptake ◽  
Cardiac Rhythm ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Strong Association ◽  
Review Of The Literature ◽  
Cardiac Outcomes ◽  
Pubmed Database ◽  
Hypothalamic Pituitary Axis

OBJECTIVE: To describe the pathophysiological basis linking cardiovascular disease (CVD) and depression; to discuss the causal relationship between them, and to review the effects of antidepressant treatment on cardiovascular disease. METHOD: A review of the literature based on the PubMed database. DISCUSSION: Depression and cardiovascular disease are both highly prevalent. Several studies have shown that the two are closely related. They share common pathophysiological etiologies or co-morbidities, such as alterations in the hypothalamic-pituitary axis, cardiac rhythm disturbances, and hemorheologic, inflammatory and serotoninergic changes. Furthermore, antidepressant treatment is associated with worse cardiac outcomes (in case of tricyclics), which are not observed with selective serotonin reuptake inhibitors. CONCLUSION: Although there is a strong association between depression and cardiovascular disease, it is still unclear whether depression is actually a causal factor for CVD, or is a mere consequence, or whether both conditions share a common pathophysiological etiology. Nevertheless, both conditions must be treated concomitantly. Drugs other than tricyclics must be used, when needed, to treat the underlying depression and not as mere prophylactic of cardiac outcomes.

Field Driving Test Situations for Ml Tank Drivers

1983 ◽  
Vol 27 (7) ◽  
pp. 545-545
Author(s):  
Susan L. Burroughs ◽  
Roy C. Campbell ◽  
Charlotte H. Campbell ◽  
C. Mazie Knerr
Keyword(s):  
Internal Consistency ◽  
Quantitative Data ◽  
Driving Performance ◽  
Simulator Training ◽  
Survey Analysis ◽  
Rater Reliability ◽  
Driving Skills ◽  
Driver Performance ◽  
General Field

The presentation deals with the testing of Ml tank drivers and focuses on the requirement to establish reliable measures of nonprocedural portions of the tank driver's job. Tests of tank driving skills have been difficult to develop because of situational reliability problems. Actual conduct of the tests with 60 ton tanks change the driving terrain for each subsequent subject. Further, problems of rater reliability in the use of observational ratings and checklists have been encountered. The purposes of the present study were (a) to develop test methodologies for tank driving that would enable these problems to be overcome and (b) to evaluate these methodologies by developing and assessing a battery of on–tank tests of nonprocedural, tactical Ml tank driving skills. Eleven driving tasks for which tests were to be developed were derived from an ARI criticality survey. Analysis of the tasks resulted in decisions to test nine of the tasks, but only those aspects that related to the driver and that were feasible for testing. Five of the tests were Obstacle/Judgment tests, and four were Tactical tests. The tests were tried out on 77 soldiers in two Ml OSUT classes (none of the soldiers took all the tests). The data were used to assess scorer agreement and internal consistency, to estimate utility based on reliability and variability, and to direct revisions and recommendations for future testing. For each of the nine tests, the data indicated that driver performance could be measured reliably. Both the Obstacle/Judgment tests and Tactical tests had been designed so that usable quantitative data could be obtained, and for every test, refinements were suggested based on data and on informal observations. For two of the Tactical tests, an innovative scoring technique using an Ml tank profile overlay was explored. Despite high ratings in the criticality survey, one Obstacle/Judgment test was recommended for deletion. While more replications and developmental refinements of the tests are needed, the analysis and development performed have produced tests that are already minimally reliable. The tests were designed for use in measuring on–tank driving performance against which to assess driver simulator training. They may also be useful in general field applications for training.

scholarly journals Antidepressant-induced jitteriness/anxiety syndrome: systematic review

2009 ◽  
Vol 194 (6) ◽  
pp. 483-490 ◽  
Author(s):  
Lindsey I. Sinclair ◽  
David M. Christmas ◽  
Sean D. Hood ◽  
John P. Potokar ◽  
Andrea Robertson ◽  
...  
Keyword(s):  
Side Effects ◽  
Anxiety Disorders ◽  
Time Course ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scales ◽  
Antidepressant Treatment ◽  
Incidence Rates ◽  
Conclusive Evidence ◽  
Response To Treatment ◽  
Robust Evidence

BackgroundEarly worsening of anxiety, agitation and irritability are thought to be common among people commencing antidepressants, especially for anxiety disorders. This phenomenon, which may be termed jitteriness/anxiety syndrome, is cited as an explanation for early treatment failure and caution in using selective serotonin reuptake inhibitors (SSRIs). However, we believe that it is inconsistently defined and that robust evidence to support the phenomenon is lacking.AimsTo review systematically all evidence relating to jitteriness/ anxiety syndrome to identify: constituent symptoms; medications implicated; disorders in which it was reported; incidence; time course; management strategies; relationship of this syndrome to therapeutic response; distinction between syndrome and akathisia; relationship between syndrome and suicide; and genetic predispositions.MethodA systematic search identified articles and these were included in the review if they addressed one of the above aspects of jitteriness/anxiety syndrome.ResultsOf 245 articles identified, 107 articles were included for review. No validated rating scales for jitteriness/anxiety syndrome were identified. There was no robust evidence that the incidence differed between SSRIs and tricyclic antidepressants, or that there was a higher incidence in anxiety disorders. Published incidence rates varied widely from 4 to 65% of people commencing antidepressant treatment. Common treatment strategies for this syndrome included a slower titration of antidepressant and the addition of benzodiazepines. Conclusive evidence for the efficacy of these strategies is lacking. There was conflicting and inconclusive evidence as to whether the emergence of this syndrome had a predictive value on the response to treatment. It appears to be a separate syndrome from akathisia, but evidence for this assertion was limited. The effect of jitteriness/anxiety syndrome on suicide rates has not been evaluated. Three studies examined genetic variations and side-effects from treatment, but none was specifically designed to assess jitteriness/anxiety syndrome.ConclusionsJitteriness/anxiety syndrome remains poorly characterised. Despite this, clinicians' perception of this syndrome influences prescribing and it is cited to support postulated mechanisms of drug action. We recommend systematised evaluation of side-effects at earlier time points in antidepressant trials to further elucidate this clinically important syndrome.

Personal and Clinical Factors Associated with Older Drivers’ Self-Awareness of Driving Performance

2020 ◽  
pp. 1-15 ◽  
Author(s):  
Yu-Ting Chen ◽  
Isabelle Gélinas ◽  
Barbara Mazer ◽  
Anita Myers ◽  
Brenda Vrkljan ◽  
...  
Keyword(s):  
Processing Speed ◽  
Driving Performance ◽  
Older Drivers ◽  
Driving Safety ◽  
Driving Ability ◽  
Accurate Estimation ◽  
Self Awareness ◽  
Motor Processing ◽  
Two Factors ◽  
Trail Making

ABSTRACT Most older adults perceive themselves as good drivers; however, their perception may not be accurate, and could negatively affect their driving safety. This study examined the accuracy of older drivers’ self-awareness of driving ability in their everyday driving environment by determining the concordance between the perceived (assessed by the Perceived Driving Ability [PDA] questionnaire) and actual (assessed by electronic Driving Observation Schedule [eDOS]) driving performance. One hundred and eight older drivers (male: 67.6%; age: mean = 80.6 years, standard deviation [SD] = 4.9 years) who participated in the study were classified into three groups: underestimation (19%), accurate estimation (29%), and overestimation (53%). Using the demographic and clinical functioning information collected in the Candrive annual assessments, an ordinal regression showed that two factors were related to the accuracy of self-awareness: older drivers with better visuo-motor processing speed measured by the Trail Making Test (TMT)-A and fewer self-reported comorbid conditions tended to overestimate their driving ability, and vice versa.

scholarly journals Effects of Smoking Cannabis on Visual Function and Driving Performance. A Driving-Simulator Based Study

2020 ◽  
Vol 17 (23) ◽  
pp. 9033
Author(s):  
Sonia Ortiz-Peregrina ◽  
Carolina Ortiz ◽  
José J. Castro-Torres ◽  
José R. Jiménez ◽  
Rosario G. Anera
Keyword(s):  
Visual Function ◽  
Driving Simulator ◽  
Driving Performance ◽  
Driving Under The Influence ◽  
Driving Safety ◽  
Limited Information ◽  
Baseline Session ◽  
Visual Effects ◽  
Awareness Campaigns ◽  
Car Driving

Cannabis is the most widely used illegal drug in the world. Limited information about the effects of cannabis on visual function is available, and more detail about the possible impact of visual effects on car driving is required. This study investigated the effects of smoking cannabis on vision and driving performance, and whether these effects are correlated. Twenty drivers and occasional users were included (mean (SE) age, 23.3 (1.0) years; five women). Vision and simulated driving performance were evaluated in a baseline session and after smoking cannabis. Under the influence of cannabis, certain visual functions such as visual acuity (p < 0.001), contrast sensitivity (p = 0.004) and stereoacuity (far, p < 0.001; near, p = 0.013) worsened. In addition, there was an overall deterioration of driving performance, with the task of keeping the vehicle in the lane proving more difficult (p < 0.05). A correlation analysis showed significant associations between driving performance and visual function. Thus, the strongest correlations were found between the distance driven onto the shoulder and stereoacuity, for near (ρ = 0.504; p = 0.001) and far distances (ρ = 0.408; p = 0.011). This study provides the first evidence to show that the visual effects of cannabis could impact driving performance, compromising driving safety. The results indicate that information and awareness campaigns are essential for reducing the incidence of driving under the influence of cannabis.

Recent Developments in Geriatric Psychopharmacotherapy

1994 ◽  
Vol 39 (8_suppl) ◽  
pp. 9-18 ◽  
Author(s):  
Alastair J. Flint
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Bipolar Affective Disorder ◽  
Unipolar Depression ◽  
The Elderly ◽  
Blood Levels ◽  
Pharmacological Management ◽  
Treatment Of Depression ◽  
Recent Developments ◽  
Psychiatric Complications

This paper highlights recent advances in the pharmacological management of geriatric affective disorders and dementia. The current roles of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) in the treatment of depression in old age are discussed. Recent findings pertaining to continuation and maintenance of antidepressant treatment are also addressed. The treatment of bipolar affective disorder in the elderly has received much less study than has unipolar depression. A number of issues relating to efficacy, side-effects and optimal blood levels of lithium, carbamazepine and valproate in bipolar disorder remain unresolved and await further study. Finally, drug treatment of the cognitive impairment and psychiatric complications of Alzheimer's disease is reviewed.

scholarly journals Antiepileptic drugs as a new therapeutic concept for the prevention of cognitive impairment and Alzheimer’s disease. Recent advances

2015 ◽  
Vol 23 (2) ◽  
pp. 139-147 ◽  
Author(s):  
Krzysztof Sendrowski ◽  
Wojciech Sobaniec
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Antiepileptic Drugs ◽  
Clinical Studies ◽  
Experimental Models ◽  
Brain Pathology ◽  
Therapeutic Concept ◽  
Neuronal Hyperexcitability ◽  
Pubmed Database

SummaryIntroduction.Excessive accumulation of amyloid-beta (Aβ) peptides in the brain results initially in mild cognitive impairment (MCI) and finally in Alzheimer’s disease (AD). Evidences from experimental and clinical studies show that pathological hyperexcitability of hippocampal neurons is a very early functional impairment observed in progressive memory dysfunctions. Therefore, antiepileptic drugs (AEDs) whose mechanism of action is aimed at inhibition of such neuronal hyperexcitability, seems to be an rationale choice for MCI and AD treatment.Aim.To provide data from experimental and clinical studies on: 1. The unfavorable impact of neuronal hyperexcitability, mainly within the hippocampus, on cognitive processes. 2. Efficacy of AEDs against such abnormally elevated neuronal activity for the prevention of progressive cognitive impairment.Methods.A literature review of publications published within the last fifteen years, was conducted using the PubMed database.Review.The authors describe Aβ-induced hyperexcitability of hippocampal nerve cells as the cause of cognitive deficits, the connection of such activity with an increased risk of seizures and epilepsy in patients with MCI/AD, and finally the efficacy of AEDs: valproic acid (VPA), phenytoin (PHT), topiramate (TPM), lamotrigine (LTG), ethosuximide (ESM) and levetiracetam (LEV) in the prevention of cognitive impairment in experimental models and patients with MCI/AD.Conclusions.The majority of the studied AEDs improve cognitive dysfunction in various experimental models of Aβ-induced brain pathology with accompanied neuronal hyperexcitability. The promising results achieved for LEV in animal models of cognitive impairment were also confirmed in patients with MCI/AD. LEV was well-tolerated and it’s beneficial antidementive effect was confirmed by memory tests and fMRI examination. In conclusion, the use of AEDs could be a novel therapeutic concept for preventing cognitive impairment in patients with Aβ-associated brain pathology.

Must we fear antidepressants in adolescents?

2017 ◽  
Vol 41 (S1) ◽  
pp. S450-S451
Author(s):  
S. Paulino ◽  
N. Santos ◽  
A.C. Almeida
Keyword(s):  
Major Depression ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Good Deal ◽  
Epidemiological Studies ◽  
Scientific Data ◽  
The Media ◽  
Media Hype ◽  
Competing Interest

IntroductionEpidemiological studies have established that teenager's prevalence rates of major depression are significant (10%). The media has given a good deal of attention to the potential risks of antidepressants and their connection to increased suicidality (especially in children and adolescents). These concerns have had a significant impact on both the prescribing of antidepressants and the parental fears about their use. It is interesting to note that in large groups’ studies of adolescents treated with selective serotonin reuptake inhibitors there have been no evidence of increased suicidal risk.ObjectiveUnderstand if there is a significant association between antidepressant treatment and suicidality in a 3-months follow-up study of the adolescent's consultation of Centro Hospitalar Lisboa Norte.MethodsAnalysis of 81 adolescents with an initial diagnosis of major depression treated with an antidepressant for at least 3 months.ResultsAfter the follow-up period there has been an improvement in sadness in 92.6% of the adolescents, a remission of death thoughts in 98.8% and an absence of suicides attempts. In 61.7%, it was necessary to introduce also an antipsychotic in a low dose and in 12.3% another antidepressant with a hypnotic effect.ConclusionIt is clear that untreated major depression carries significant suffering and disability. Although treatment with antidepressants may take several weeks before clinical improvement appear and depression may worsen in the first days, its therapeutic effect should not be underestimated even if becomes necessary to add another medication in the first days. In evaluating these kinds of concerns, we must always differentiate between media hype and scientific data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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