2010 BC Guide in Determining Fitness to Drive

Sedating EffectLowModerateHighTCAsdesipramine [Norpramin®], nortriptyline [Aventyl®], amoxapine[Asendin®]imipramine [Tofranil®]amitriptyline [Elavil®], doxepin [Sinequan®]Selective serotonin-reuptake inhibitorsSSRIs generally have fewer side effects than TCAs. Nonetheless, some studies have shownimpairments in both cognitive and psychomotor functioning in individuals using SSRIs.Dual action antidepressantsResearch indicates that DAAs (atypical antidepressants included), the most recently introducedclass of antidepressants, have fewer side effects than TCAs or SSRIs, but cognitive impairmentassociated with depression and/or treatment may still be present.AntiepilepticsAnticonvulsants may impair motor and sensory functions, producing: ataxia (lack of coordination; unsteadiness) nystagmus (uncontrollable rapid eye movement) blurring and double vision tremor poor concentration, and/or slowed thinkingDisruption of normal cognitive function is a frequent and pervasive side effect of anticonvulsantdrugs. A variety of cognitive abilities may be affected, including memory, reaction time,executive functioning, and problem solving.The known side effects of first generation anticonvulsant drugs (phenobarbital, phenytoin,benzodiazepines, and valproate) include sedation and cognitive dysfunction. Adverse cognitiveeffects, including impairments in memory and attention, are also evident with the use of morerecently introduced anticonvulsant drugs (e.g., topiramate), though these generally have fewerside effects.AntihistaminesHistamine is involved in many brain functions, including the waking-sleep cycle, attention,memory, learning and excitation. The effects of antihistamines differ depending on theirgeneration. Older antihistamines, such as tripolidine [Actifed®], dephenhydramine[Benadryl®], and clemastine or terfenadine [Seldane®] are associated with profound sedation,impaired psychomotor function, and blurred vision.Newer antihistamines, such as:361