The association between antidepressant use and deaths from road traffic accidents: a case-crossover study

Bo Ram Yang, Kyoung eun Kwon, Ye Jee Kim, Nam Kyong Choi, Mi Sook Kim, Sun Young Jung, Ju Young Shin, Yong Min Ahn, Byung Joo Park, Joongyub Lee

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Purpose: Antidepressants are some of the most commonly used psychiatric medications, but little information is available about the effects of antidepressant treatment on the risk of traffic accidents across classes of antidepressants or associated with each substance individually. To investigate the relationship between exposure to antidepressants and risk of fatality in road traffic accidents. Methods: We used a Korean national road traffic authority database linked with a national health insurance database between January 1, 2010 and December 31, 2014 and applied a case-crossover design. The study subjects were drivers in South Korea who died from traffic accidents and who had prescriptions for antidepressants within 1 year prior to the date of the accident. We compared the status of prescription for antidepressants with the hazard period and four matched control periods using conditional logistic regression, adjusting for other drug use. The trends of antidepressant utilization were described in terms of the number of prescriptions. A case–case-time-control design was applied to drugs with an increasing trend in use and a significant case-crossover odds ratio (OR). Results: A total of 1250 antidepressant-using drivers were included, and an increased risk was observed during the 30-day hazard period (adjusted OR 1.30; 95% CI 1.03–1.63). Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) showed significant risks, but tricyclic antidepressants did not. However, the associations of all antidepressants, SSRIs, SNRIs, escitalopram, and duloxetine did not remain significant after adjusting for trends in utilization. Paroxetine and milnacipran were associated with increased risks, with no obvious increase in their utilization, but the possibility of confounding by indication could have affected the results for milnacipran. Conclusion: Considering the trends of antidepressant prescription and utilization, the use of paroxetine increased the risk of fatal traffic accidents.

Original languageEnglish
Pages (from-to)485-495
Number of pages11
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number4
StatePublished - 3 Apr 2019

Bibliographical note

Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.


  • Antidepressants
  • Case-crossover design
  • Pharmacoepidemiology
  • Traffic accidents


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