What is the efficacy of Buspirone (buspirone) for treating anxiety and depression?

From the Guidelines

Buspirone is not the preferred medication for treating depression, as augmenting with bupropion decreases depression severity more than augmentation with buspirone. When considering buspirone for anxiety and depression, it's essential to weigh the benefits and harms. According to a clinical practice guideline from the American College of Physicians 1, low-quality evidence showed no difference in suicidal ideas and behavior or serious adverse events between bupropion and buspirone. However, moderate-quality evidence indicated that discontinuation due to adverse events was lower with bupropion than with buspirone.

Some key points to consider when using buspirone for anxiety and depression include:

• Buspirone may be effective for treating anxiety disorders, particularly generalized anxiety disorder
• It can be used alongside antidepressants to help with depression symptoms
• The typical starting dose is 7.5 mg, gradually increasing to 20-30 mg daily
• Common side effects include dizziness, headache, nausea, and nervousness
• Buspirone works differently from benzodiazepines, making it non-sedating and non-addictive with no withdrawal symptoms

It's crucial to prioritize the patient's quality of life, morbidity, and mortality when making treatment decisions. In this case, bupropion may be a better option than buspirone for treating depression, as it has been shown to decrease depression severity more effectively 1. However, the decision to use buspirone or bupropion should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.

From the FDA Drug Label

Buspirone hydrochloride tablets are indicated for the management of anxiety disorder or the short-term relief of the symptoms of anxiety. Many of the patients enrolled in these studies also had coexisting depressive symptoms and buspirone hydrochloride tablets relieved anxiety in the presence of these coexisting depressive symptoms

Buspirone can be used for the management of anxiety disorder, and it has been shown to relieve anxiety in patients with coexisting depressive symptoms. However, it is not explicitly indicated for the treatment of depression.

• Anxiety relief in patients with coexisting depressive symptoms has been demonstrated.
• The effectiveness of buspirone in treating depression is not directly addressed in the label 2.

From the Research

Buspirone for Anxiety and Depression

• Buspirone is an azapirone derivative and a 5-HT1A partial agonist, used for the treatment of generalized anxiety disorder 3.
• It has been shown to have anxiolytic properties similar to those of benzodiazepines, but with increased safety and lack of dependency-producing aspects 3, 4.
• Buspirone is most helpful in anxious patients who do not demand immediate gratification or the immediate relief associated with benzodiazepines 3.
• It has also been found to have antidepressant effects, particularly in patients with mixed symptoms of anxiety and depression 3, 5, 6.

Efficacy in Generalized Anxiety Disorder

• Buspirone has been shown to be effective in the treatment of generalized anxiety disorder, with efficacy comparable to diazepam or chlorazepate 4.
• A study found that buspirone was superior to placebo in improving anxiety and depressive symptoms in patients with generalized anxiety disorder and coexisting mild depressive symptoms 6.

Augmentation of Selective Serotonin Reuptake Inhibitors

• Buspirone augmentation of selective serotonin reuptake inhibitors (SSRIs) may be beneficial in the treatment of depression refractory to treatment with an SSRI 5.
• A study found that patients with severe depressive symptoms may benefit from augmentation with buspirone, and that it may speed up the antidepressive response of patients refractory to treatment with fluoxetine or citalopram 5.

Mechanism of Action

• Buspirone's mechanism of action is thought to involve interaction with dopamine and serotonin receptors, particularly the 5-HT1A serotonin receptor 4, 7.
• It does not act on the GABA receptor, and its effects are mediated by other neurotransmitter systems, including serotonin, norepinephrine, and acetylcholine 4, 7.