The association between antidepressant use and deaths from road traffic accidents: a case-crossover study

  • Bo Ram Yang
  • Kyoung-eun Kwon
  • Ye-Jee Kim
  • Nam-Kyong Choi
  • Mi-Sook Kim
  • Sun-Young Jung
  • Ju-Young Shin
  • Yong Min Ahn
  • Byung-Joo Park
  • Joongyub LeeEmail author
Original Paper



Antidepressants are some of the most commonly used psychiatric medications, but little information is available about the effects of antidepressant treatment on the risk of traffic accidents across classes of antidepressants or associated with each substance individually. To investigate the relationship between exposure to antidepressants and risk of fatality in road traffic accidents.


We used a Korean national road traffic authority database linked with a national health insurance database between January 1, 2010 and December 31, 2014 and applied a case-crossover design. The study subjects were drivers in South Korea who died from traffic accidents and who had prescriptions for antidepressants within 1 year prior to the date of the accident. We compared the status of prescription for antidepressants with the hazard period and four matched control periods using conditional logistic regression, adjusting for other drug use. The trends of antidepressant utilization were described in terms of the number of prescriptions. A case–case-time-control design was applied to drugs with an increasing trend in use and a significant case-crossover odds ratio (OR).


A total of 1250 antidepressant-using drivers were included, and an increased risk was observed during the 30-day hazard period (adjusted OR 1.30; 95% CI 1.03–1.63). Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) showed significant risks, but tricyclic antidepressants did not. However, the associations of all antidepressants, SSRIs, SNRIs, escitalopram, and duloxetine did not remain significant after adjusting for trends in utilization. Paroxetine and milnacipran were associated with increased risks, with no obvious increase in their utilization, but the possibility of confounding by indication could have affected the results for milnacipran.


Considering the trends of antidepressant prescription and utilization, the use of paroxetine increased the risk of fatal traffic accidents.


Antidepressants Traffic accidents Case-crossover design Pharmacoepidemiology 



The research was promoted as part of the ‘Technology Development for Behavior Improvement and Violation Control of High Risk Drivers’ program that was carried out by the Ministry of Land, Infrastructure and Transport in Korea (Grant Number 14TLRP-B085437-01). The funding body did not play a role in the study design, writing of the manuscript, or in the decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

The authors declared no conflict of interest.

Supplementary material

127_2018_1637_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 KB)
127_2018_1637_MOESM2_ESM.docx (88 kb)
Supplementary material 2 (DOCX 87 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Medical Research Collaborating CenterSeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of Preventive MedicineSeoul National University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Clinical Epidemiology and BiostatisticsAsan Medical CenterSeoulRepublic of Korea
  4. 4.Department of Health ConvergenceEwha Womans UniversitySeoulRepublic of Korea
  5. 5.College of PharmacyChung-Ang UniversitySeoulRepublic of Korea
  6. 6.School of PharmacySungkyunkwan UniversitySuwonRepublic of Korea
  7. 7.Department of PsychiatrySeoul National University HospitalSeoulRepublic of Korea
  8. 8.Institute of Human Behavioral MedicineSeoul National University College of MedicineSeoulRepublic of Korea
  9. 9.School of MedicineInha UniversityIncheonRepublic of Korea
  10. 10.Department of Prevention and ManagementInha University HospitalIncheonRepublic of Korea

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