Study, May/21:Driving performance under treatment of frequently prescribed drugs

The full title of this German study is "Driving performance under treatment of most frequently prescribed drugs for mental disorders: a systematic review of patient studies".

https://pubmed.ncbi.nlm.nih.gov/34038545/ 

Abstract

Background: Mobility is important for daily life functioning with particular challenges regarding road safety under pharmacological treatment in patients with a psychiatric disease.

Methods: According to PRISMA guidelines, a systematic literature search on PubMed database (January 1970 til December 2020) was performed. Primary endpoints were driving performance in on-road-tests, driving simulator performance or psychomotor and visual perception functions assessed to estimate fitness to drive according to legal regulations in patient studies.

Results: Forty studies were identified (1533 patients, 38% female, median age 45 years), more than 60% were cross-sectional and open label trials. Under steady state medication 31% (range 27%-42,5%) of schizophrenic or schizoaffective patients under antipsychotics, and 18% (range 16%-20%) of unipolar and bipolar patients under antidepressants showed severe impairment in skills relevant for driving. Data point to an advantage of second generation antipsychotics (SGAs) compared to first generation antipsychotics (FGAs) as well as modern antidepressants over tricyclic antidepressants (TCAs) with respect to driving. Most patients significantly improved or stabilized in driving skills within 2-4 weeks of treatment with non-sedative or sedative antidepressants. Diazepam significantly worsened driving the first three weeks after treatment initiation, whereas medazepam (low-dose), temazepam and zolpidem did not impair driving. In long-term users of sedating antidepressants or benzodiazepines impairments in on-road-tests were not evident.

Conclusion: Available evidence suggests that psychopharmacologic medicines improve or at least stabilize driving performance of patients under long-term treatment when given on clinical considerations. To enhance treatment compliance, existing classification systems of medicinal drugs concerning their impact on driving performance should also incorporate information about effects of long-term-treatment.