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There are many side effects associated with the use of the tricyclic antidepressants (TCAs) (e.g., amitriptyline), that are relevant to the ability to drive, such as blurred vision, slow visual accommodation, disorientation, and eye-hand coordination; the most important are the induction of drowsiness, lethargy, and sedation. An analysis of 500 road traffic accidents showed that victims who had taken TCAs had a relative accident risk 2.2 times greater than non-TCA users and that patients using TCAs with a daily dose greater than or equivalent to 125 mg of amitriptyline had a sixfold increase in road traffic crash risk (83). The newer antidepressant drugs of the serotonin reuptake inhibitor class (e.g., fluoxetine, paroxetine, or the selective serotonin and noradrenaline re-uptake inhibitors [venlafaxine]) do not generally affect driving performance and are safe for use by patients who drive (84).

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