CNS Drugs

, Volume 21, Issue 6, pp 503–519 | Cite as

Impact of Psychotropic Medications on Simulated Driving

A Critical Review
Review Article

Abstract

Driving a motor vehicle is central to the functional autonomy of patients with psychiatric illnesses. There have been many studies of the deleterious effects of psychotropic medications such as benzodiazepines, typical antipsychotics and tricyclic antidepressants (TCAs) on human motor skills; however, in the literature little attention has been paid to how such impairment affects driving ability. Computerised driving simulators offer a laboratory-based method of assessing the effects of specific psychotropic medications on driving abilities, in a standardised, controlled and safe manner. The purpose of the present article is to review research undertaken to-date on the effects of psychotropic medications on computer-simulated driving.

A search of various databases, including MEDLINE, EMBASE and PsycInfo, was conducted. Forty-one articles assessing the impact of psychotropics on computer-simulated driving were identified. The pooled total number of subjects assessed in these simulator studies was 1336 (mean sample size 30.36 [SD 35.8]).The most common outcome measures in the various studies were speed, steering, deviation from lateral position (tracking, lane drifting), reaction time or braking accuracy, driving errors (e.g. errors in turning, coordination, gap acceptance, signalling, following distance) and vehicle collisions. The results of the studies were quite variable; however, the most common drug-related impairments included those of tracking and reaction time. Benzodiazepines and TCAs were most commonly associated with impairment, although the level of impairment was dependent on the population studied, the dose and the time of testing relative to drug administration.

Computer-simulated driving provides a useful tool to research psychotropicrelated impairment of driving abilities. Limitations of currently available data include the lack of generalisability, standardisation and small sample sizes.

Notes

Acknowledgements

During the period 2000–2006, Dr Rapoport received honoraria from Janssen-Ortho, Avanir/Cerebrio, Eli Lilly, Pfizer, AstraZeneca and Lundbeck for speaking engagements and advisory boards. Ms Baniña has no conflicts of interest that are directly relevant to the contents of this review. Funding for Ms Baniña was provided in part by the Physician’s Services Inc. Foundation. The authors would like to thank Daniel Glick, BA, and Marie Vanier, PhD, for their assistance in compiling the data, and Nathan Herrmann, MD, FRCPC, and Henry Moller, MD, FRCPC, for their review of the manuscript. Preliminary data from this investigation was presented at the Harvey Stancer Research Day of the Department of Psychiatry at the University of Toronto on 16 June 2005.

References

  1. 1.
    Moskowitz H, Robinson CD. Effects of low doses of alcohol on driving skills: a review of the evidence. DOT-HS-800-599. Washington, DC: National Highway Traffic Safety Administration, 1988Google Scholar
  2. 2.
    Jones R, Lacey J. Alcohol and highway safety 2001: a review of the state of knowledge. DOT-HS-809-383. Washington, DC: National Highway Traffic Safety Administration, 2001Google Scholar
  3. 3.
    Asbridge M, Mann RE, Flam-Zalcman R, et al. The criminalization of impaired driving in Canada: assessing the deterrent impact of Canada’s first per se law. J Stud Alcohol 2004; 65(4): 450–9PubMedGoogle Scholar
  4. 4.
    Russell A, Voas RB, Dejong W, et al. MADD rates the states: a media advocacy event to advance the agenda against alcoholimpaired driving. Public Health Rep 1995; 110(3): 240–5PubMedGoogle Scholar
  5. 5.
    Hamilton WJ. Mothers against drunk driving: MADD in the USA. Inj Prev 2000; 6(2): 90–1PubMedCrossRefGoogle Scholar
  6. 6.
    Beirness DJ, Simpson HM, Desmond K. The road safety monitor 2002: drugs and driving. Ottawa (ON): Traffic Injury Research Foundation, 2003Google Scholar
  7. 7.
    Kelly E, Darke S, Ross J. A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions. Drug Alcohol Rev 2004; 23(3): 319–44PubMedCrossRefGoogle Scholar
  8. 8.
    Brookhuis KA, De Vries G, De Waard D. Acute and subchronic effects of the H1-histamine receptor antagonist ebastine in 10, 20 and 30mg dose, and triprolidine 10mg on car driving performance. Br J Clin Pharmacol 1993; 36(1): 67–70PubMedCrossRefGoogle Scholar
  9. 9.
    Gengo FM, Manning C. A review of the effects of antihistamines on mental processes related to automobile driving. J Allergy Clin Immunol 1990; 86 (6 Pt 2): 1034–9PubMedCrossRefGoogle Scholar
  10. 10.
    Mamdani M, Rapoport M, Shulman Kl, et al. Mental healthrelated drug utilization among older adults: prevalence, trends, and costs. Am J Geriatr Psychiatry 2005; 13(10): 892–900PubMedGoogle Scholar
  11. 11.
    Barker MJ, Greenwood KM, Jackson M, et al. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs 2004; 18(1): 37–48PubMedCrossRefGoogle Scholar
  12. 12.
    Mishara AL, Goldberg TE. A meta-analysis and critical review of the effects of conventional neuroleptic treatment on cognition in schizophrenia: opening a closed book. Biol Psychiatry 2004; 55(10): 1013–22PubMedCrossRefGoogle Scholar
  13. 13.
    Oxman TE. Antidepressants and cognitive impairment in the elderly. J Clin Psychiatry 1996; 57Suppl. 5: 38–44PubMedGoogle Scholar
  14. 14.
    Thomas RE. Benzodiazepine use and motor vehicle accidents: systematic review of reported association. Can Fam Physician 1998; 44: 799–808PubMedGoogle Scholar
  15. 15.
    Leveille SG, Buchner DM, Koepsell TD, et al. Psychoactive medications and injurious motor vehicle collisions involving older drivers. Epidemiology 1994; 5(6): 591–8PubMedCrossRefGoogle Scholar
  16. 16.
    Ray WA, Fought FL, Decker MD. Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am J Epidemiol 1992; 136(7): 873–83PubMedCrossRefGoogle Scholar
  17. 17.
    Etminan M, Hemmelgarn B, Delaney JA, et al. Use of lithium and the risk of injurious motor vehicle crash in elderly adults: case-control study nested within a cohort. BMJ 2004; 328(7439): 558–9PubMedCrossRefGoogle Scholar
  18. 18.
    Gengo FM, Gabos C, Straley C, et al. The pharmacodynamics of ethanol: effects on performance and judgment. J Clin Pharmacol 1990; 30(8): 748–54PubMedGoogle Scholar
  19. 19.
    Arnedt JT, Wilde GJ, Munt PW, et al. Simulated driving performance following prolonged wakefulness and alcohol consumption: separate and combined contributions to impairment. J Sleep Res 2000; 9(3): 233–41PubMedCrossRefGoogle Scholar
  20. 20.
    Liguori A, d’Agostino Jr RB, Dworkin SI, et al. Alcohol effects on mood, equilibrium, and simulated driving. Alcohol Clin Exp Res 1999; 23(5): 815–21PubMedCrossRefGoogle Scholar
  21. 21.
    Rizzo M, McGehee DV, Dawson JD, et al. Simulated car crashes at intersections in drivers with Alzheimer disease. Alzheimer Dis Assoc Disord 2001; 15(1): 10–20PubMedCrossRefGoogle Scholar
  22. 22.
    Bylsma FW. Simulators for assessing driving skills in demented patients. Alzheimer Dis Assoc Disord 1997; 11Suppl. 1:17–20PubMedCrossRefGoogle Scholar
  23. 23.
    Akinwuntan AE, De Weerdt W, Feys H, et al. Effect of simulator training on driving after stroke: a randomized controlled trial. Neurology 2005; 65(6): 843–50PubMedCrossRefGoogle Scholar
  24. 24.
    Vanakoski J, Mattila MJ, Seppala T. Driving under light and dark conditions: effects of alcohol and diazepam in young and older subjects. Eur J Clin Pharmacol 2000; 56(6-7): 453–8PubMedCrossRefGoogle Scholar
  25. 25.
    Moore NC. Medazepam and the driving ability of anxious patients. Psychopharmacology (Berl) 1977; 52(1): 103–6CrossRefGoogle Scholar
  26. 26.
    Tornros J, Vikander B, Ahlner J, et al. Simulated driving performance of benzodiazepine users. J Traffic Med 2001; 29(3–4): 4–15Google Scholar
  27. 27.
    Mattila MJ, Kuitunen T, Veilahti J. Related coordinative, reactive and cognitive performances as impaired by drugs and alcohol: comparison with clinical test for driving fitness. J Traffic Med 1993; 21(3): 101–14Google Scholar
  28. 28.
    Dureman I, Norrman B. Clinical and experimental comparison of diazepam, chlorazepate and placebo. Psychopharmacologia 1975; 40(4): 279–84PubMedCrossRefGoogle Scholar
  29. 29.
    Friedel B, Sjoo S, Reker K, et al. Testing drivers taking diazepam in the Daimler-Benz driving simulator. J Traffic Med 1991; 19(1): 15–27Google Scholar
  30. 30.
    Linnoila M, Hakkinen S. Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving. Clin Pharmacol Ther 1974; 15(4): 368–73PubMedGoogle Scholar
  31. 31.
    Linnoila M. Drug interaction on psychomotor skills related to driving: hypnotics and alcohol. Ann Med Exp Biol Fenn 1973; 51(3): 118–24PubMedGoogle Scholar
  32. 32.
    Irving A, Jones W. Methods for testing impairment of driving due to drugs. Eur J Clin Pharmacol 1992; 43(1): 61–6PubMedCrossRefGoogle Scholar
  33. 33.
    Silveira P, Vas-da-Silva M, Dolgner A, et al. Psychomotor effects of mexazolam vs placebo in healthy volunteers. Clin Drug Invest 2002; 22(10): 677–84CrossRefGoogle Scholar
  34. 34.
    Tornros J, Laurell H. Acute and carry-over effects of brotizolam compared to nitrazepam and placebo in monotonous simulated driving. Pharmacol Toxicol 1990; 67: 77–80PubMedCrossRefGoogle Scholar
  35. 35.
    Mattila M. Acute and subacute effects of diazepam on human performance: comparison of plain tablet and controlled release capsule. Pharmacol Toxicol 1988; 63(5): 369–74PubMedCrossRefGoogle Scholar
  36. 36.
    Nichols JM, Martin F. P300 in heavy social drinkers: the effect of lorazepam. Alcohol 1993; 10(4): 269–74PubMedCrossRefGoogle Scholar
  37. 37.
    Schroeder SR, Ewing JA, Allen JA. Combined effects of alcohol with methapyrilene and chlordiazepoxide on driver eye movements and errors. J Safety Res 1974; 6(2): 89–93Google Scholar
  38. 38.
    Stevenson GW, Pathria MN, Lamping DL, et al. Driving ability after intravenous fentanyl or diazepam: a controlled doubleblind study. Invest Radiol 1986; 21(9): 717–9PubMedCrossRefGoogle Scholar
  39. 39.
    Vanakoski J, Seppala T, Stromberg C, et al. Effects of ceronapril alone or in combination with alcohol on psychomotor performance in healthy volunteers: a placebo-controlled, crossover, study. Curr Ther Res 2001; 62(10): 699–708CrossRefGoogle Scholar
  40. 40.
    Willumeit HP, Ott H, Neubert W, et al. Alcohol interaction of lormetazepam, mepindolol sulphate and diazepam measured by performance on the driving simulator. Pharmacopsychiatry, 1984; 17(2): 36–43PubMedCrossRefGoogle Scholar
  41. 41.
    Iudice A, Bonanni E, Maestri M, et al. Lormetazepam effects on daytime vigilance, psychomotor performance and simulated driving in young adult healthy volunteers. Int J Clin Pharmacol Ther 2002; 40(7): 304–9PubMedGoogle Scholar
  42. 42.
    Laurell H, Tornros J. The carry-over effects of triazolam compared with nitrazepam and placebo in acute emergency driving situations and in monotonous simulated driving. Acta Pharmacol Toxicol (Copenh) 1986; 58(3): 182–6CrossRefGoogle Scholar
  43. 43.
    Saario I, Linnoila M. Effect of subacute treatment with hypnotics, alone or in combination with alcohol, on psychomotor skills related to driving. Acta Pharmacol Toxicol (Copenh) 1976; 38(4): 382–92CrossRefGoogle Scholar
  44. 44.
    Volkerts ER, van Laar MW, Maes RAA. A comparative study of on-the-road and simulated driving performance after nocturnal treatment with lormetazepam 1mg and oxazepam 50 mg. Hum Psychopharmacol 1992; 7: 297–309CrossRefGoogle Scholar
  45. 45.
    Willumeit HP, Neubert W, Ott H, et al. Driving ability following the subchronic application of lormetazepam, flurazepam and placebo. Ergonomics 1983; 26(11): 1055–61PubMedCrossRefGoogle Scholar
  46. 46.
    Partinen M, Hirvonen K, Hublin C, et al. Effects of aftermidnight intake of zolpidem and temazepam on driving ability in women with non-organic insomnia. Sleep Med 2003; 4(6): 553–61PubMedCrossRefGoogle Scholar
  47. 47.
    Mattila MJ, Vanakoski J, Kalska H, et al. Effects of alcohol, zolpidem, and some other sedatives and hypnotics on human performance and memory. Pharmacol Biochem Behav 1998; 59(4): 917–23PubMedCrossRefGoogle Scholar
  48. 48.
    Kuitunen T. Drug and ethanol effects on the clinical test for drunkenness: single doses of ethanol, hypnotic drugs and antidepressant drugs. Pharmacol Toxicol 1994; 75(2): 91–8PubMedCrossRefGoogle Scholar
  49. 49.
    Staner L, Ertle S, Boeijinga P, et al. Next-day residual effects of hypnotics in DSM-IV primary insomnia: a driving simulator study with simultaneous electroencephalogram monitoring. Psychopharmacology (Berl) 2005; 181(4): 790–8CrossRefGoogle Scholar
  50. 50.
    Jauhar P, McClure I, Hillary C, et al. Psychomotor performance of patients on maintenance lithium therapy. Hum Psychopharmacol 1993; 8: 141–4CrossRefGoogle Scholar
  51. 51.
    Bocca ML, Le Doze F, Etard O, et al. Residual effect of zolpidem 10mg and zopiclone 7.5mg versus flunitrazepam lmg and placebo on driving performance and ocular saccades. Psychopharmacology (Berl) 1999; 143(4): 373–9CrossRefGoogle Scholar
  52. 52.
    Linnoila M. Effects of diazepam, chlordiazepoxide, thioridazine, haloperidole, flupenthixole and alcohol on psychomotor skills related to driving. Ann Med Exp Biol Fenn 1973; 51(3): 125–32PubMedGoogle Scholar
  53. 53.
    Moskowitz H, Smiley A. Effects of chronically administered buspirone and diazepam on driving-related skills performance. J Clin Psychiatry 1982; 43 (12 Pt 2): 45–55PubMedGoogle Scholar
  54. 54.
    Linnoila M, Saario I, Maki M. Effect of treatment with diazepam or lithium and alcohol on psychomotor skills related to driving. Eur J Clin Pharmacol 1974; 7(5): 337–42PubMedCrossRefGoogle Scholar
  55. 55.
    Brunnauer A, Laux G, Geiger E, et al. The impact of antipsychotics on psychomotor performance with regards to car driving skills. J Clin Psychopharmacol 2004; 24(2): 155–60PubMedCrossRefGoogle Scholar
  56. 56.
    Wylie KR, Thompson DJ, Wildgust HJ. Effects of depot neuroleptics on driving performance in chronic schizophrenic patients. J Neurol Neurosurg Psychiatry 1993; 56(8): 910–3PubMedCrossRefGoogle Scholar
  57. 57.
    Bech P, Thomsen J, Rafaelsen OJ. Long-term lithium treatment: effect on simulated driving and other psychological tests. Eur J Clin Pharmacol 1976; 10(5): 331–5PubMedCrossRefGoogle Scholar
  58. 58.
    Hatcher S, Sims R, Thompson D. The effects of chronic lithium treatment on psychomotor performance related to driving. Br J Psychiatry 1990; 157: 275–8PubMedCrossRefGoogle Scholar
  59. 59.
    Hindmarch I. Three antidepressants (amitriptyline, dothiepin, fluoxetine), with and without alcohol, compared with placebo on tests of psychomotor ability related to car driving. Hum Psychopharmacol 1987; 2: 177–83CrossRefGoogle Scholar
  60. 60.
    Hindmarch I, Harrison C. The effects of paroxetine and other antidepressants in combination with alcohol in psychomotor activity related to car driving. Hum Psychopharmacol 1988; 3: 13–20CrossRefGoogle Scholar
  61. 61.
    Mattila MJ, Patat A, Seppala T, et al. Single oral doses of amisulpride do not enhance the effects of alcohol on the performance and memory of healthy subjects. Eur J Clin Pharmacol 1996; 51(2): 161–6PubMedCrossRefGoogle Scholar
  62. 62.
    Berthelon C, Bocca ML, Denise P, et al. Do zopiclone, zolpidem and flunitrazepam have residual effects on simulated task of collision anticipation? J Psychopharmacol 2003; 17(3): 324–31PubMedCrossRefGoogle Scholar
  63. 63.
    Linnoila M, Mattila MJ. Interaction of alcohol and drugs on psychomotor skills as demonstrated by a driving simulator. Br J Pharmacol 1973; 47(3): 671–2PGoogle Scholar
  64. 64.
    Mattila MJ, Vanakoski J, Mattila-Evenden ME, et al. Suriclone enhances the actions of chlorpromazine on human psychomotor performance but not on memory or plasma prolactin in healthy subjects. Eur J Clin Pharmacol 1994; 46(3): 215–20PubMedCrossRefGoogle Scholar
  65. 65.
    Verster JC, Veldhuijzen DS, Volkerts ER. Residual effects of sleep medication on driving ability. Sleep Med Rev 2004; 8(4): 309–25PubMedCrossRefGoogle Scholar
  66. 66.
    Neutel CI. Risk of traffic accident injury after a prescription for a benzodiazepine. Ann Epidemiol 1995; 5(3): 239–44PubMedCrossRefGoogle Scholar
  67. 67.
    Sagberg F. Driver health and crash involvement: a case-control study. Accid Anal Prev 2006; 38(1): 28–34PubMedCrossRefGoogle Scholar
  68. 68.
    Yee B, Campbell A, Beasley R, et al. Sleep disorders: a potential role in New Zealand motor vehicle accidents. Intern Med J 2002; 32(7): 297–304PubMedCrossRefGoogle Scholar
  69. 69.
    Oster G, Huse DM, Adams SF, et al. Benzodiazepine tranquilizers and the risk of accidental injury. Am J Public Health 1990; 80(12): 1467–70PubMedCrossRefGoogle Scholar
  70. 70.
    Ramaekers JG. Antidepressants and driver impairment: empirical evidence from a standard on-the-road test. J Clin Psychiatry 2003; 64(1): 20–9PubMedCrossRefGoogle Scholar
  71. 71.
    Ridout F, Meadows R, Johnsen S, et al. A placebo-controlled investigation into the effects of paroxetine and mirtazapine on measures related to car driving performance. Hum Psychopharmacol 2003; 18(4): 261–9PubMedCrossRefGoogle Scholar
  72. 72.
    Thomsen J, Bech P, Geisler A, et al. Meniere’s disease: preliminary report of lithium treatment. Acta Otolaryngol 1974; 78(1–2): 59–64PubMedCrossRefGoogle Scholar
  73. 73.
    Yung CY. A review of clinical trials of lithium in neurology. Pharmacol Biochem Behav 1984; 21 Suppl. 1: 57–64PubMedCrossRefGoogle Scholar
  74. 74.
    Drachman DA, Swearer JM. Driving and Alzheimer’s disease: the risk of crashes. Neurology 1993; 43(12): 2448–56PubMedCrossRefGoogle Scholar
  75. 75.
    Friedland RP, Koss E, Kumar A, et al. Motor vehicle crashes in dementia of the Alzheimer type. Ann Neurol 1988; 24(6): 782–6PubMedCrossRefGoogle Scholar
  76. 76.
    Vaa T. Impairments, diseases, age and their, relative risks of accident involvement: results from meta-analysis. Oslo: Institute of Transport Economics, 2003. TOI Report 690/2003Google Scholar
  77. 77.
    Molnar FJ, Patel A, Marshall SC, et al. Clinical utility of officebased cognitive predictors of fitness-to-drive in persons with dementia: a systematic review. J Am Geriatr Soc 2006; 54(12): 1809–24PubMedCrossRefGoogle Scholar
  78. 78.
    Molnar FJ, Byszewski AM, Marshall SC, et al. In-office evaluation of medical fitness to drive: practical approaches for assessing older people. Can Fam Physician 2005; 51: 372–9PubMedGoogle Scholar
  79. 79.
    Beck CA, Patten SB, Williams JV, et al. Antidepressant utilization in Canada. Soc Psychiatry Psychiatr Epidemiol 2005; 40(10): 799–807PubMedCrossRefGoogle Scholar
  80. 80.
    Hogan DB, Maxwell CJ, Fung TS, et al. Prevalence and potential consequences of benzodiazepine use in senior citizens: results from the Canadian Study of Health and Aging. Can J Clin Pharmacol 2003; 10(2): 72–7PubMedGoogle Scholar
  81. 81.
    Bourin M, Briley M. Sedation, an unpleasant, undesirable and potentially dangerous side-effect of many psychotropic drugs. Hum Psychopharmacol 2004; 19(2): 135–9PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  1. 1.Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

Personalised recommendations