Driving on Antidepressants

FitnessToDriveGuidelinesLast week, my Irish friend Leonie sent me a link to the official Medical Fitness to Drive Guidelines, published by the Irish Road Safety Authority.

And to save my ploughing through the 114 pages of the document, Leonie transcribed the following paragraph on antidepressants, which concludes with an extraordinary statement.

In Section 3.9.2 on Page 16, under the heading The effects of specific medicine classes, it states:

Although antidepressants are one of the more commonly detected drug groups in fatally injured drivers, this tends to reflect their wide use in the community. The ability to impair is greater with sedating tricyclic antidepressants, such as amitriptyline and dosulepin, than with less sedating serotonin reuptake inhibitors, such as fluoxetine and sertraline, and the mixed reuptake inhibitors. However, antidepressants can reduce the psychomotor and cognitive impairment caused by depression and return mood towards normal. This can improve driving performance.”

In the UK, last March, legislation was introduced which set maximum “safe” levels for certain types of medication for drivers. Those included were benzodiazepines, such as Diazepam and Temazepam, as well as methadone and morphine. Inexplicably, antidepressants were not included on this list. Is a driver on heightened levels of antidepressants really any safer than one on heightened levels of benzos?

PeterTwyfordThis morning, I read a report of an inquest which took place yesterday in Cannock, Staffordshire. The court heard that 41-year-old Peter Twyford (right) had been prescribed antidepressants after a marital breakdown.

On September 12th last year, just after returning from a holiday on his own to Egypt, Peter texted his wife to tell her that he was leaving, and set out from Wolverhampton, along the A449 into Staffordshire. Moments later, Peter drove his Vauxhall Zafira into an articulated lorry that had been parked in a lay-by.

Peter died in the collision, and nobody else was injured. Police investigators found no skid marks to suggest that Peter had applied his brakes, no evidence that the car had swerved and nothing to suggest that he may have fallen asleep at the wheel. All the evidence from the crash scene indicated Mr Twyford deliberately drove his car into the lorry.

Toxicology tests revealed that no more than the recommended dosage of antidepressants was found in his body. There was no alcohol found, and no other drugs or medication. Coroner Margaret Jones concluded that Peter died by suicide.

Just last week, an inquest that concerned a similar tragic incident took place in Berwick-upon-Tweed, Northumberland. On February 20th last year, a 50-year-old driver* died when he drove his Rover 45 on the wrong side of the carriageway and crashed into an oncoming Scania tipper lorry. The lorry driver said the car made no attempt to swerve or slow down and, despite his own evasive actions, the car hit his lorry at speed.
The senior crash investigator told the inquest: “It’s my opinion that the actions taken by (the driver) were deliberate but to what degree they were influenced by his state of mind is unclear.”

The inquest heard that the driver had been seen by a doctor after a relationship break-up, and had been signed off from work. He had received a psychiatric assessment which recommended he receive further treatment and counselling. He had had suicidal thoughts, but medical experts felt there was no intent. A letter from the driver’s daughter cast doubts on the quality of mental health care he had received.

Coroner Tony Brown concluded: “The facts I have heard are that (the driver) expressed suicidal ideas. He was in a highly anxious and emotional state, evidenced by the confusing array of notes left in his flat. I am not satisfied he had any clear intention to take his own life.”

In my database, which has identified more than 6000 instances of self-inflicted deaths in England and Wales linked to antidepressants, there are many examples of those who have died by driving their car into other vehicles, trees, walls, or even over cliffs.

MichaelMcCroryLast year in Liverpool, for example, an inquest heard how popular teacher Michael McCrory walked out of a mental health ward between observations and, hours later, died when he drove his car into a tree. At the inquest, Michael’s widow said that that she felt her late husband’s medication had been handled unprofessionally in the lead-up to his death.

There are so many more similar stories that could be told, but three inquest reports are particularly interesting for the reaction of the coroners concerned.

GeraintWilliamsIn February 2013, Worcestershire coroner Geraint Williams (right) conducted the inquest of Alex Martin, a 27-year-old care worker, who died after his car (top of page) swerved directly into the path of a lorry. He had written a number of suicide notes, and the inquest was told that it was only thanks to the quick-thinking actions of the lorry driver that more vehicles were not involved in the crash. A post-mortem report showed that Alex had not been under the influence of drink or drugs, but that “therapeutic levels of the anti-depressant Sertraline” were found in his blood.

The report states that Mr Williams carefully considered whether it was suicide, but eventually he recorded an open verdict.

The following day, the same local newspaper reported on the inquest of 64-year-old Christine Guise, a retired NHS worker who drove straight through a give-way line and hit an HGV lorry.

In a police statement, the unfortunate lorry driver said that Mrs Guise had been staring at the steering wheel. “She was looking slightly down and not focused on anything, she never looked up the road and I never saw her looking at me.”

A post-mortem report found there was no medical emergency or natural disease such as stroke or heart attack which would have caused the accident. Christine was not under the influence of drink or drugs, but therapeutic levels of Citalopram were found.

Summing up, Mr Williams said: “… it’s quite clear Mrs Guise was driving her vehicle quite deliberately when it went through the junction which led to the crash. Therefore I find she died as a result of accidental death.” For the second time in two days,  Mr Williams ignored completely the existence of antidepressants which, in all probability, had been responsible for the loss of two lives.

IanSmithFive years earlier, in March 2008, Cumbria coroner Ian Smith (left) conducted the inquest of retired bank manager Nigel Woodburn, who took his life by driving his car into a tree, just four days after he was prescribed Citalopram. He told the inquest that he would be contacting drug authorities because he feared that people were killing themselves after taking antidepressants.

He said: “I have to say this is probably the fifth, if not sixth inquest I’ve heard within a period of three years when somebody either just going on to Citalopram or Seroxat, or coming off it, have killed themselves one way or another, totally out of the blue, totally without expectation, without a history of suicidal thoughts in the past.”

The following month, however, at the inquest of another antidepressant-induced suicide, the local newspaper reported: “Mr. Smith went on to say that he had dealt with six to eight cases in a short period where people had taken their lives days after starting antidepressant drugs and he had reported these concerns to the health authorities despite coming under criticism for speaking out.

After that “criticism”, and until his retirement 6½ years later, Ian Smith had nothing more to say in public about the dangers of antidepressants.

It would be absurd to contend that anybody who is taking antidepressants is capable of suicidal driving as soon as they get behind the wheel of their car. On the other hand, I fail to understand the logic of the Road Safety Authority when they claim that a mind-altering drug like an SSRI “can improve driving performance.”

Research in the USA on behalf of the National Center for Biotechnology Information (NCBI) in 2009 found that: “Antidepressants are commonly prescribed medications that carry an imprecise risk of driving impairment…While there may be a small risk of driving impairment with these medications, this risk is considerably heightened under particular clinical conditions. These conditions include the advanced age of the driver, initial dosing and start-up of the antidepressant, rapid escalation of antidepressant doses, high-dose antidepressants…and/or co-administration of other psychotropic medications, especially benzodiazepines. Clinicians need to be mindful of these specific clinical conditions when prescribing antidepressants to patients.”

In the UK, those driving vehicles such as lorries or buses may have their licence suspended by the DVLA if they have “serious” anxiety or depression, defined as “more severe anxiety states or depressive illnesses with significant memory or concentration problems, agitation, behavioural disturbance, or suicidal thoughts.” It would not be returned “until the person has been well and stable for six months and until they are satisfied that medication is not causing any side-effects which would interfere with alertness or concentration.”

These rules are less stringent than those for train-drivers and pilots. Neither of these is allowed to work in the UK while they are on antidepressants.

But even if driving is not seriously impaired, the presence of antidepressants can cause a driver to be more impatient, intolerant or aggressive, which may result in a minor accident or in a driving offence being committed. At such an incident, police officers would take an interest in how much alcohol a driver may have consumed. Perhaps the time has come for types and levels of medication to be recorded as a matter of course, so that evidence can be collated to find out just how safe it really is to be driving on antidepressants.


* Since writing the article, I have been contacted by a close relative of the driver involved in the accident in Northumberland. As requested, I have consequently removed the driver’s name from the article.

7 Replies to “Driving on Antidepressants”

  1. I used to have a terrible fear of driving on motorways, having gone through a windscreen in an earlier accident in my life as a passenger, and would avoid motorways at all costs. I would prefer to drive the long way round, missing out on a 2 hour motorway journey for a 5 hour back roads one.
    Once on Paroxetine and then Citalopram, though, my fears completely vanished and I thought nothing of driving in the outside lane of a motorway doing 70 mph. In fact I was so overconfident I felt as if my car was not going fast enough!
    When I came off the SSRI medication and went back on to the motorway, I was not as confident to put my foot down and consider myself a much safer driver now. SSRIs do affect your driving performance, without a doubt.

  2. I took Paroxetine (Seroxat) too. I was so disinhibited at times I’d consider driving over a roundabout rather than brake on its approach. My impulse control was so impaired I was potentially lethal. Utterly ridiculous if you think SSRIs improve your driving, 20 mg of Seroxat and one (legal) pint and you could be driving with an equivalent impairment of 6 pints. I thought the RSA knew what they were talking about!

  3. Levels of antidepressants in a person’s blood are of no consequence. They are not like alcohol where a predictable response and recovery is known.
    Antidepressants damage the brain from the first dose: one may recover from this damage or not, it is a very individual thing, the damage may remain long after the drug has left a person’s system. Suicide is the tragic consequence for some, previously stable people, who take these drugs.

  4. I am sorry, I don’t follow some of your conclusions. In the summary of the Irish Traffic Agency’s report, it concludes that driver’s are safer taking SSRI’s as these can “reduce the psychomotor and cognitive impairment associated with depression and return mood towards normal.” This means drivers are safer taking medications because they don’t have reduced reaction times and mood swings caused by the disease, not the medication. Many of the cases you cite involve suicide, which is more likely in someone not being treated for depression. One case indicated that the driver had taken more than the prescribed dosage of the medication. This does not show that the medication would have been unsafe at prescribed levels. Applying this argument would ban most medications from any use. Paracetamol is fatal at levels just above normal safe therapuetic levels, for example. It also depends on the medication and the individual’s response to the medication. Older anti-depressants were sedatives and could affect concentration, etc. SSRI’s, in the main, are not. However, when first prescribed the side effects can be more severe for the first few weeks. Every driver should assess their fitness to drive when sitting behind the wheel. If you don’t feel 100% you shouldn’t drive. So, it is good practice for someone just starting on any new medication to monitor their ability to drive more carefully and refrain from driving if they think they are in anyway impaired. This applies to any driver, so the one suffering from a hangover, migraine or dodgy stomach should also refrain from driving. Taking alcohol with any medication (even at otherwise legal levels) can increase the side effects of the medication and also make you more susceptible to the effects of the alcohol (get drunk on less) because the medication increases the speed and efficiency of the alcohol getting to your bloodstream and brain. Many antidepressants have a warning not to drink alcohol.If a driver was to ignore this warning and have any amount of alcohol and then drive this could have serious consequences. If you do this and continue to drive even when you realise your judgement is impaired and you’re drunk or uninhibited then you are committing a criminal offense. This is not the fault of the medication, but the fault of the driver who ignored the warning on the medication and continued to drive knowing they were impaired. It would not be an excuse to say I was on medication. As with all medications and driving, common sense and the individuals taking responsibility for their actions are just as important. I have no interests in the Pharmaceutical industry, I just find some of the arguments a little difficult to follow logically.

    • Thank you for contacting me, and for taking an interest in my article about those who have deliberately taken their lives while driving a car.
      I need to let you know that, along with the other articles I have written about SSRI-induced akathisia, I don’t use “arguments”. I merely relate facts.
      The article in question was written over 3 years ago, in response to a paragraph in an official Irish document about road safety. I don’t know whether it has been amended since then.
      In the intervening 3 years in the UK, further incidents have taken place where drivers on, or withdrawing from, antidepressants have used their cars as a means of taking their lives, by driving into other vehicles, roadside objects, or over cliffs.
      On occasions, other people have died as a result of a driver using a motor vehicle as a means of suicide. The most infamous incident happened in March 2012, when a bus driver in Switzerland deliberately drove his vehicle into the wall of a road tunnel in Switzerland while withdrawing from Paroxetine. His passengers were schoolchildren and their teachers. 28 people died, of whom 22 were children between 10 and 12 years old. Another 24 children were injured and traumatised.
      And of course, in terms of the number of lives, the most costly suicide was that of Andreas Lubitz in 2015, who, unknown to his employers, had been prescribed Mirtazapine and Citalopram before he crashed a Germanwings plane into the side of a mountain, killing 150 others on board.
      I have never maintained that drivers on antidepressants will inevitably attempt to crash their car. But, a few have done so, and I reported some of these incidents in my article.
      A Swedish study found that approximately 2/3 of adults who took their lives did so after a prescription of antidepressants. More take their lives by hanging than by any other means. But some means of suicide impact on others who may become involved. Just as SSRIs can induce a person to jump from a motorway bridge or in front of a train, they can do so while the person is driving a car.
      These are not arguments; these are facts.

  5. The fact is there is no conclusive evidence to suggest that taking medications which make you well contribute to dangerous driving. However, the taking of ones’ life whilst driving a vehicle most definitely impacts others.
    It is also true that nearly all suicides regardless of how they are committed do in fact affect more than one person. Drivers are more likely a risk unto themselves and others by using a mobile phone, conversing with passengers and or general careless driving. It is only a real danger when first starting out on medications, when doses are changed and during cessation.
    You are not required by law to notify the DVLA unless you have a serious impairment, which include: bi polar disorder, schizophrenia etc. All people suffer with impatience, intolerance, poor anticipation, poor time management, emotional distress and more yet are not impaired by driving. And so it would be wrong to assume that taking antidepressants which help you to be well, would constitute a higher risk than those who do not.
    The advice for anybody concerned is to ask your doctor. Depression and anxiety is not a requirement to notify dvla, unless your doctor has concerns and or you become a general risk to yourself or others.It is also worth noting that those who drink the legal amount of alcohol are more at risk than those on relatively low doses of antidepressants.

  6. It is true that many more deaths on the roads of the UK are caused by alcohol than by psychotropic medication.
    However, the difference is that, in most cases, those drivers whose judgement is impaired by alcohol do not intend to lose their lives, or even to wreck their cars. Since I wrote the article over four years ago, drivers suffering from SSRI-induced akathisia have continued to use their vehicles as a means of ending their lives.
    I refer you to the reply above, written in June last year. Nothing has changed.

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