From the Research
Buspirone is generally preferred over hydroxyzine as an anxiolytic treatment for menstrual dysphoria due to its efficacy in reducing symptoms of anxiety and irritability without causing sedation or dependence. Buspirone is typically started at 5-10 mg twice daily and can be gradually increased to 20-30 mg daily in divided doses, as seen in a study where the mean daily dose of buspirone was 21 +/- 6 mg during the luteal phase only and 27 +/- 10 mg when taken daily throughout the menstrual cycle 1. It works by targeting serotonin 5-HT1A receptors, which helps regulate mood and anxiety. Buspirone takes 2-4 weeks to reach full effectiveness, so it should be started before symptoms are expected and continued throughout the menstrual cycle.
Some key points to consider when prescribing buspirone for menstrual dysphoria include:
- Its efficacy in reducing symptoms of anxiety and irritability, as demonstrated in a study where buspirone was significantly superior to placebo in self-rated global improvement 1
- Its relatively low incidence of side effects, such as sedation, compared to other anxiolytic treatments 2
- Its potential as a useful alternative for patients experiencing sexual dysfunction when treated with selective serotonin reuptake inhibitors (SSRIs) 1
- The need for further studies to fully explore its efficacy and side effects in the treatment of menstrual dysphoria, particularly in comparison to other treatments like fluoxetine 3
In contrast, hydroxyzine is primarily an antihistamine with sedating properties that make it less suitable for ongoing menstrual dysphoria management. Its side effects of drowsiness and dry mouth can interfere with daily functioning, making buspirone a more appropriate choice for the cyclical nature of menstrual dysphoria. However, individual responses vary, and some patients may benefit from hydroxyzine for acute symptom management while buspirone builds effectiveness. A study comparing buspirone and fluoxetine in the treatment of premenstrual syndrome found that both treatments were effective, but buspirone had fewer side effects 3. Another study suggested that symptom-onset treatment with paroxetine CR was effective in reducing symptoms of premenstrual dysphoric disorder, but further evaluation is needed to determine the optimal treatment approach 4. Overall, buspirone's efficacy, safety profile, and relatively low incidence of side effects make it a preferred treatment option for menstrual dysphoria.