title: Depression, antidepressants and driving safety.
abstract: BACKGROUND
  The purpose of this study was to review to review the reported associations of depression and antidepressants with motor vehicle crashes.
  
  
  OBJECTIVE
  A literature search for material published in the English language between January, 1995, and October, 2015, in bibliographic databases was combined with a search for other relevant material referenced in the retrieved articles.
  
  
  METHODS
  Retrieved articles were systematically reviewed for inclusion criteria: 19 epidemiological studies (17 case-control and 2 cohort studies) fulfilled the inclusion criteria by estimating the crash risk associated with depression and/or psychotropic medications in naturalistic settings.
  
  
  RESULTS
  The estimates of the odds ratio (OR) of crash involvement associated with depression ranged from 1.78 to 3.99. All classes of antidepressants were reported to have side effects with the potential to affect driving safety. The majority of studies of antidepressant effects on driving reported an elevated crash risk, and ORs ranged from 1.19 to 2.03 for all crashes, and 3.19 for fatal crashes. In meta-analysis, depression was associated with approximately 2-fold increased crash risk (summary OR = 1.90; 95% CI, 1.06 to 3.39), and antidepressants were associated with approximately 40% increased crash risk (summary OR = 1.40; 95%CI, 1.18 to 1.66).
  
  
  CONCLUSIONS
  Based on the findings of the studies reviewed, depression, antidepressants or the combination of depression and antidepressants may pose a potential hazard to driving safety. More research is needed to understand the individual contributions of depression and the medications used to treat depression.
authors.affiliation: Department of Family Medicine and Public Health, San Diego, USA. llhill@ucsd.edu.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Hill
authors.affiliation: Department of Psychiatry, San Diego, USA.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Lauzon
authors.affiliation: Department of Family Medicine and Public Health, San Diego, USA.
authors.forename: Elise L
authors.initials: EL
authors.lastname: Winbrock
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, New York, USA.
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
authors.affiliation: Center for Injury Epidemiology and Prevention, Columbia University Medical Center, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.
authors.forename: Stanford
authors.initials: S
authors.lastname: Chihuri
authors.affiliation: Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Lee
keywords: Antidepressants; Crashes; Depression; Driving; Intentional crashes