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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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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2397-2409"},"PeriodicalIF":4.5000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of Initiating Different Antidepressant Subclasses on Motor Vehicle Crash Risk Among Older Adults With Depression\",\"authors\":\"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\",\"doi\":\"10.1111/jgs.19527\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":17240,\"journal\":{\"name\":\"Journal of the American Geriatrics Society\",\"volume\":\"73 8\",\"pages\":\"2397-2409\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Geriatrics Society\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19527\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Geriatrics Society","FirstCategoryId":"3","ListUrlMain":"https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19527","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
Effects of Initiating Different Antidepressant Subclasses on Motor Vehicle Crash Risk Among Older Adults With Depression
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.
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.
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