Can depression and antidepressant medication, such as fluoxetine (Selective Serotonin Reuptake Inhibitor (SSRI)) or sertraline (SSRI), affect a person's ability to drive?

Impact of Depression and Antidepressant Medication on Driving Ability

Both depression itself and antidepressant medications can significantly impair a person's ability to drive safely, with the risk varying based on medication type, timing of treatment, and severity of depression.

Effects of Depression on Driving

• Depression can impair driving performance through cognitive deficits, reduced concentration, and psychomotor slowing, potentially increasing accident risk 1
• The severity of depression positively correlates with the degree of driving impairment - more severe depression leads to worse driving performance 1
• Untreated depressed patients show significantly higher standard deviation of lateral position (SDLP) - a measure of "weaving" while driving - compared to healthy controls 1

Effects of Antidepressant Medications on Driving

Medication Type Matters

• Sedating antidepressants (tricyclic antidepressants, mianserin, mirtazapine) cause significant driving impairment comparable to blood alcohol concentration of 0.8 mg/mL after acute doses 2
• Non-sedating antidepressants (SSRIs like fluoxetine, paroxetine, sertraline) generally have minimal effects on driving performance when used alone 2
• Population studies show a slight increase in traffic accident risk with both sedating (SIR=1.4) and non-sedating antidepressants (SIR=1.6) 3

Timing of Treatment Is Critical

• Highest risk period: Initial dosing and start-up phase of antidepressant treatment 4
• Acute doses of sedating antidepressants cause significant impairment, but partial tolerance develops after 1-2 weeks of treatment for most medications 5
• Mirtazapine shows dose-dependent driving impairment after first dose (15-30mg) comparable to blood alcohol concentration of 0.05% 5

Specific Warnings for Sertraline (SSRI)

• FDA labeling for sertraline specifically warns: "patients should be told that until they learn how they respond to sertraline they should be careful doing activities when they need to be alert, such as driving a car or operating machinery" 6

High-Risk Scenarios

• Combined medications: Particularly dangerous combinations include non-sedating antidepressants with benzodiazepines 2
• Advanced age: Elderly drivers are at higher risk for driving impairment with antidepressants 4
• Rapid dose escalation: Quick increases in antidepressant doses heighten risk of driving impairment 4
• High-dose regimens: Higher doses correlate with greater impairment 4

Clinical Recommendations

• Exercise caution during initiation: Warn patients about potential driving impairment when starting antidepressant treatment 6, 4
• Monitor for individual side effects: Even with medications showing minimal population-level effects, individual patients may experience significant impairment 7
• Reassess driving ability: After stabilization on maintenance doses, reevaluate driving capacity 7
• Consider medication timing: Evening dosing of sedating antidepressants may minimize next-day driving impairment 2
• Treat depression effectively: Properly treated depression actually improves driving performance compared to untreated depression 1

Common Pitfalls to Avoid

• Assuming absence of population-level effects means individual patients won't experience driving impairment 7
• Failing to provide specific driving warnings when initiating antidepressant treatment 6
• Not recognizing that depression itself impairs driving, independent of medication effects 1
• Overlooking potential interactions between antidepressants and other medications that may compound driving impairment 2