From the Guidelines
Buspar (buspirone) is generally not recommended as a first-line treatment for bipolar disorder, as it may exacerbate manic symptoms or induce mood swings 1. However, in some cases, it may be used off-label to treat anxiety symptoms in patients with bipolar disorder, but only under close supervision and at low doses (5-10 mg twice daily) 1.
Key Considerations
- Close supervision: Patients with bipolar disorder who are taking buspirone should be closely monitored for signs of manic episodes or worsening bipolar symptoms 1.
- Low doses: Buspirone should be started at a low dose and gradually increased as needed, while also considering the use of a mood stabilizer to mitigate potential risks 1.
- Mood stabilizer: The use of a mood stabilizer may be necessary to mitigate the potential risks of buspirone in patients with bipolar disorder 1.
Potential Risks
- Manic episodes: Buspirone may trigger manic episodes or worsen bipolar symptoms in some patients 1.
- Anxiety symptoms: Buspirone may be effective in treating anxiety symptoms in patients with bipolar disorder, but it should be used with caution and under close supervision 1.
- Discontinuation due to adverse events: Discontinuation due to adverse events was lower with bupropion than with buspirone in some studies 1.
From the Research
Safety of Buspar in Bipolar Disorder
- There is limited direct evidence on the safety of Buspar (buspirone) in bipolar disorder 2, 3, 4, 5, 6.
- Buspirone is primarily used to treat generalized anxiety disorder and has been shown to be effective in reducing anxiety symptoms in patients with depressive disorders 3, 5, 6.
- However, its use in bipolar disorder is not well-studied, and most guidelines recommend the use of mood stabilizers, atypical antipsychotics, and antidepressants as first-line treatments for bipolar depression 2, 4.
- Some studies suggest that buspirone may be useful in treating anxiety symptoms in patients with depressive disorders, including those with bipolar disorder, but more research is needed to fully understand its safety and efficacy in this population 5, 6.
- A recent study found that adjunctive buspirone therapy effectively improved anxiety symptoms in depressed patients taking antidepressants, regardless of baseline symptom severity or buspirone dosage, with few adverse events reported 6.
Potential Risks and Benefits
- The use of buspirone in bipolar disorder may be associated with a risk of precipitating a switch into mania, although this risk may be minimized when used in combination with a mood stabilizer 4.
- Buspirone may also have benefits in terms of reducing anxiety symptoms and improving depressive symptoms in patients with bipolar disorder, although more research is needed to fully understand its effects in this population 5, 6.
- The safety and efficacy of buspirone in bipolar disorder may depend on various factors, including the patient's specific diagnosis, symptom severity, and concomitant medications 2, 3, 4, 5, 6.