title: Are selective serotonin reuptake inhibitors safe for drivers? What is the evidence?
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors (SSRIs) are widely used medications to treat several psychiatric diseases and, above all, depression. They seem to be as effective as older antidepressants but have a different adverse effect profile. Despite their favorable safety profile, little is known about their influence on traffic safety.
  
  
  OBJECTIVE
  To conduct a literature review to summarize the current evidence on the role of SSRIs in traffic safety, particularly concerning undesirable effects that could potentially impair fitness to drive, experimental and pharmacoepidemiologic studies on driving impairment, 2 existing categorization systems for driving-impairing medications, and the European legislative procedures for assessing fitness to drive before issuing a driver's license and driving under the influence of medicines.
  
  
  METHODS
  The article search was performed in the following electronic databases: MEDLINE, PsycINFO, ScienceDirect, and SafetyLit. The English-language scientific literature was searched using key words such as SSRIs and psychomotor performance, car crash or traffic accident, and adverse effects. For inclusion in this review, papers had to be full-text articles, refer to possible driving-related adverse effects, and be experimental or pharmacoepidemiologic studies on SSRIs and traffic accident risks. No restrictions concerning publication year were applied.
  
  
  RESULTS
  Ten articles were selected as background information on driving-related adverse effects, and 15 articles were selected regarding experimental and pharmacoepidemiologic work. Regarding SSRI adverse effects, the most reported undesirable effects referring to driving impairment were anxiety, agitation, sleep disturbances, headache, increased risk of suicidal behavior, and deliberate self-harm. Regarding the remaining issues addressed in this article, inconsistencies were found between the outcomes of the selected experimental and epidemiologic studies and between the 2 existing categorization systems under evaluation. Some pitfalls of the current legislative scenario were identified as well.
  
  
  CONCLUSIONS
  Based on the current evidence, it was concluded that more experimental and epidemiologic research is needed to elucidate the relationship between SSRI use and traffic safety. Furthermore, a revision of the existing categorization systems and harmonized European legislation in the field of medication use and driving were highly recommended.
authors.affiliation: Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, the Netherlands. s.ravera@rug.nl
authors.forename: Silvia
authors.initials: S
authors.lastname: Ravera
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Ramaekers
authors.forename: Lolkje T W
authors.initials: LT
authors.lastname: de Jong-van den Berg
authors.forename: Johan J
authors.initials: JJ
authors.lastname: de Gier
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001334:Automobile Driving; D003863:Depression / Q000188:drug therapy; D006801:Humans; D017891:Pharmacoepidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors