Effects of Initiating Different Antidepressant Subclasses on Motor Vehicle Crash Risk Among Older Adults With Depression

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2025-05-20 DOI:10.1111/jgs.19527

Marzan A. Khan, Nina R. Joyce, Melissa R. Pfeiffer, Melissa R. Riester, Brian R. Ott, Arman Oganisian, Allison E. Curry, Seth A. Margolis, Andrew R. Zullo

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引用次数: 0

Abstract

Background

Antidepressants are prescribed for depression among older adults but might increase the risk of motor vehicle crash (MVC) through adverse effects (AEs) like sedation, dizziness, and blurred vision. Antidepressant subclasses may have different MVC risks since AE risks vary across subclasses. Our objective was to estimate the comparative one-year risks of MVC upon initiating atypical (AA) or tricyclic (TCA) versus selective serotonin reuptake inhibitor (SSRI) antidepressants.

Methods

We emulated 470 sequential target trials each week from January 6, 2008, through January 1, 2017, using Medicare fee-for-service claims linked to New Jersey police-reported MVCs and driver's licensing data. Our sequential target trial emulation included older adults aged ≥ 66 years with a recent diagnosis of depression who initiated AAs, SSRIs, or TCAs. The unit of analysis was the “person-trial” a unique instance of a person in a sequential trial. Using inverse probability of treatment and censoring weighted Kaplan–Meier estimators to account for potential confounding and selection bias, we estimated the intention-to-treat cumulative incidence and risk ratios (RRs) of MVC over 1 year of follow-up.

Results

We identified 13,034 person-trials from 11,604 persons (median [first quartile, third quartile] age: 76.0 [71.0, 82.0] years, 69.8% female, 89.4% non-Hispanic White race). There were 31 (37.6 [95% confidence limits {CLs} 20.3, 59.5] per 1000), 65 (37.6 [95% CLs 25.7, 47.7] per 1000), and 380 (38.0 [95% CLs 24.1, 39.7] per 1000) MVCs among 644 TCA-treated, 2130 AA-treated, and 10,260 SSRI-treated person-trials, respectively. The adjusted RRs were 0.99 (95% CLs 0.72, 1.56) comparing AAs versus SSRIs and 0.99 (95% CLs 0.56, 1.86) comparing TCAs versus SSRIs.

Conclusion

We observed no differences in the one-year risk of MVC between antidepressant subclasses. When selecting among antidepressant subclasses to manage depression in older adults, MVC risk should not guide prescribing decisions, and other considerations should take precedence.

Abstract Image

查看原文本刊更多论文

不同抗抑郁药亚类对老年抑郁症患者机动车碰撞风险的影响。

背景：抗抑郁药是为老年人抑郁症开的处方，但可能通过镇静、头晕和视力模糊等不良反应增加机动车碰撞（MVC）的风险。抗抑郁药亚类可能具有不同的MVC风险，因为不同亚类的AE风险不同。我们的目的是评估在开始使用非典型（AA）或三环（TCA）抗抑郁药与选择性5 -羟色胺再摄取抑制剂（SSRI）抗抑郁药后，MVC一年的风险比较。方法：从2008年1月6日至2017年1月1日，我们每周模拟470次连续目标试验，使用与新泽西州警方报告的mvc和驾驶执照数据相关的医疗保险按服务收费索赔。我们的顺序目标试验模拟包括年龄≥66岁且最近诊断为抑郁症的老年人，他们开始服用AAs、SSRIs或TCAs。分析的单位是“人-试验”，即连续试验中一个人的独特实例。使用治疗逆概率和加权Kaplan-Meier估计来考虑潜在的混杂和选择偏倚，我们估计了1年随访期间MVC的意向治疗累积发病率和风险比（rr）。结果：我们从11,604人中确定了13,034人-试验（中位数[第一、第三四分位数]年龄：76.0[71.0,82.0]岁，69.8%为女性，89.4%为非西班牙裔白人）。在644例tca治疗、2130例aa治疗和10260例ssri治疗的患者试验中，分别有31例（37.6例[95%置信区间{CLs} 20.3, 59.5] / 1000）、65例（37.6例[95%置信区间}25.7,47.7]/ 1000）和380例（38.0例[95%置信区间}24.1,39.7]/ 1000）mvc。AAs与SSRIs的校正后的rr为0.99 (95% CLs 0.72, 1.56)， TCAs与SSRIs的校正后的rr为0.99 （95% CLs 0.56, 1.86）。结论：我们观察到抗抑郁药亚类之间一年MVC风险无差异。在选择抗抑郁药亚类来治疗老年人抑郁症时，MVC风险不应指导处方决策，而应优先考虑其他因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.