Crying After Starting Buspirone: A Recognized Adverse Effect
Yes, crying that begins after starting buspirone (Buspar) can be a side effect of the medication, and you should contact your prescriber to discuss discontinuation or dose adjustment.
Understanding the Side Effect Profile
The FDA drug label for buspirone documents emotional and neuropsychiatric adverse effects that can manifest as crying or emotional lability 1. Specifically:
- Central nervous system effects reported in clinical trials include nervousness (5% vs 1% placebo), depression (2%), and emotional disturbances 1
- Postmarketing surveillance has identified "emotional lability" as a recognized adverse effect, though rare 1
- Infrequent adverse effects (occurring in 1/100 to 1/1000 patients) include dysphoria, depersonalization, and fearfulness 1
Clinical Context: The "Jitteriness Syndrome"
Research has documented a specific syndrome of buspirone-induced agitation and emotional distress 2. In patients with anxiety disorders, buspirone can paradoxically cause:
- Increased anxiety levels
- Agitation and restlessness
- Pressured speech and racing thoughts
- Emotional dysregulation (which can manifest as crying)
This syndrome typically appears shortly after treatment initiation and completely resolves when buspirone is discontinued 1, 2. The mechanism may involve buspirone's effects on noradrenergic activity or dopaminergic systems, potentially representing a form of akathisia 1.
Important Clinical Distinctions
Differentiate from underlying depression: While buspirone can cause depression as a side effect (2% incidence in trials) 1, the FDA label notes that some patients with secondary depression from ADHD-related problems may actually improve when treated 3. However, the label also warns that "buspirone can produce dysphoria in vulnerable patients" and advises caution in prescribing to patients with unstable mood disorders 3.
Timing matters: The crying started after initiating buspirone, which strongly suggests a drug-related effect rather than progression of underlying anxiety or depression.
Management Algorithm
- Immediate action: Contact your prescriber before the next dose
- Do not abruptly stop if you've been taking it for more than 2 weeks, as gradual taper may be needed
- Your prescriber should:
- Discontinue buspirone if symptoms are distressing 2
- Consider alternative anxiolytics (the evidence shows CBT has similar efficacy to buspirone for anxiety with lower discontinuation rates) 4
- If switching medications, note that augmentation with bupropion has lower discontinuation rates due to adverse events (12.5%) compared to buspirone (20.6%) in depression treatment 5
Critical Safety Considerations
Higher risk populations for adverse neuropsychiatric effects include 1, 2, 6:
- Patients with panic disorder (may experience paradoxical jitteriness)
- Those with psychotic disorders (buspirone can worsen psychosis through dopaminergic effects)
- Individuals with substance use history (case reports document problematic use patterns) 7
Monitor for escalation: If crying is accompanied by suicidal ideation, severe agitation, or psychotic symptoms, seek immediate medical attention. These are documented rare but serious adverse effects 1.
The moderate-quality evidence from the STAR*D trial shows that when buspirone fails or causes intolerable side effects as an augmentation strategy, switching to cognitive therapy or bupropion are evidence-based alternatives with better tolerability profiles 5.