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Effects of Initiating Different Antidepressant Subclasses on Motor Vehicle Crash Risk Among Older Adults With
Marzan A Khan1,2, Nina R Joyce1,2, Melissa R Pfeiffer3
1Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.
Journal of the American Geriatrics Society
|May 20, 2025
Summary
Antidepressant subclasses, including atypical (AA), tricyclic (TCA), and selective serotonin reuptake inhibitor (SSRI) types, showed no significant difference in motor vehicle crash (MVC) risk for older adults. Prescribing decisions for depression management should prioritize other factors over MVC risk.
Area of Science:
- Geriatric pharmacology
- Public health and safety
- Epidemiology of adverse drug events
Background:
- Antidepressants are commonly prescribed for depression in older adults.
- Adverse effects of antidepressants, such as sedation and dizziness, may increase motor vehicle crash (MVC) risk.
- Different antidepressant subclasses may pose varying risks for MVCs due to differing adverse effect profiles.
Purpose of the Study:
- To compare the one-year risk of motor vehicle crashes (MVCs) associated with initiating atypical antidepressants (AAs) or tricyclic antidepressants (TCAs) versus selective serotonin reuptake inhibitors (SSRIs) in older adults.
- To inform clinical decision-making regarding antidepressant selection in elderly populations by assessing comparative MVC risks.
Main Methods:
- Emulation of 470 sequential target trials weekly from 2008-2017 using Medicare claims data linked to MVC and driver's licensing records.
- Inclusion of older adults (≥66 years) with a recent depression diagnosis initiating AAs, SSRIs, or TCAs.
- Application of inverse probability of treatment and censoring weighted Kaplan-Meier estimators to determine one-year cumulative incidence and risk ratios (RRs) of MVC.
Main Results:
- The study analyzed 13,034 person-trials from 11,604 individuals (median age 76 years, 69.8% female).
- MVC rates per 1000 person-trials were 37.6 for TCAs, 37.6 for AAs, and 38.0 for SSRIs.
- Adjusted risk ratios showed no significant difference: 0.99 (95% CLs 0.72, 1.56) for AAs vs. SSRIs and 0.99 (95% CLs 0.56, 1.86) for TCAs vs. SSRIs.
Conclusions:
- No significant difference in the one-year risk of motor vehicle crashes was observed between atypical antidepressants, tricyclic antidepressants, and selective serotonin reuptake inhibitors.
- Motor vehicle crash risk should not be a primary factor when selecting among antidepressant subclasses for managing depression in older adults.
- Other clinical considerations should guide antidepressant prescribing decisions in this population.
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