Go to content

Combination of medications increases at-fault crash risk for elderly drivers


Older drivers are at increased risk of having an at-fault motor vehicle crash (MVC) while combining antidepressants with another psychotropic medication, new research has found.

“Antidepressants alone did not increase MVC risk, unless prescribed with another psychotropic drug. Then we saw an increased risk,” says Dr. Mark Rapoport, lead investigator of the study and psychiatrist at Sunnybrook Health Sciences Centre.

The study, a collaboration between the Institute for Clinical Evaluative Sciences (ICES), Ontario Ministries of Health and Transportation and Sunnybrook Health Sciences Centre, found the at-fault MVC risk was highest during the first four months that the antidepressant and another psychotropic medication, such as benzodiazepines or anticholinergics, were being taken.

Benzodiazepines are often used as a therapy for sleep or anxiety problems and are the most commonly prescribed psychoactive drug in North America, while some drugs used to treat gastrointestinal and respiratory disorders have potent anticholinergic properties.

“Clinicians, including physicians and pharmacists, should warn patients of the increased MVC risks they face in the first few months of taking an antidepressant, especially if the patient is elderly and is taking other medications,” says Rapoport, who is also Associate Professor in the Department of Psychiatry at University of Toronto.

Dr. Donald Redelmeier, an ICES Senior Scientist and co-author on the study, agrees. “Elderly drivers often have additional chronic illnesses that increase MVC risk. Special attention is needed when complex patients are taking multiple medications, since impaired driving creates risks for the driver and other vulnerable road users,” he says.

The authors of the study hope that future research focuses on whether it is the effects of the drug or the symptoms of depression that are causing the increased crash risks among the elderly population.

The study was funded by the Canadian Institutes of Health Research, Institute of Aging, and is appearing in the December issue of The American Journal of Geriatric Psychiatry.

Sunnybrook Health Sciences Centre is inventing the future of healthcare for the one million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for Canada’s war veterans, high-risk pregnancies, critically-ill newborns, adults and the elderly, and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Sybil Edmonds
  • Communications Advisor, Sunnybrook Health Sciences
  • [email protected]
  • (416) 480-4040


Contributing ICES Scientists

Research Programs

Associated Sites

Read the Journal Article