TY - JOUR
T1 - The association between antidepressant use and deaths from road traffic accidents
T2 - a case-crossover study
AU - Yang, Bo Ram
AU - Kwon, Kyoung eun
AU - Kim, Ye Jee
AU - Choi, Nam Kyong
AU - Kim, Mi Sook
AU - Jung, Sun Young
AU - Shin, Ju Young
AU - Ahn, Yong Min
AU - Park, Byung Joo
AU - Lee, Joongyub
N1 - Funding Information:
Acknowledgements The research was promoted as part of the ‘Technology Development for Behavior Improvement and Violation Control of High Risk Drivers’ program that was carried out by the Ministry of Land, Infrastructure and Transport in Korea (Grant Number 14TLRP-B085437-01). The funding body did not play a role in the study design, writing of the manuscript, or in the decision to submit the manuscript for publication.
Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/4/3
Y1 - 2019/4/3
N2 - 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.
AB - 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.
KW - Antidepressants
KW - Case-crossover design
KW - Pharmacoepidemiology
KW - Traffic accidents
UR - http://www.scopus.com/inward/record.url?scp=85057533341&partnerID=8YFLogxK
U2 - 10.1007/s00127-018-1637-4
DO - 10.1007/s00127-018-1637-4
M3 - Article
C2 - 30474691
AN - SCOPUS:85057533341
SN - 0933-7954
VL - 54
SP - 485
EP - 495
JO - Social Psychiatry and Psychiatric Epidemiology
JF - Social Psychiatry and Psychiatric Epidemiology
IS - 4
ER -
