What is the role of Buspirone (Anxiolytic) in the treatment of Generalized Anxiety Disorder (GAD)?

From the Guidelines

Buspirone is a recommended anxiolytic for the treatment of Generalized Anxiety Disorder (GAD), particularly for patients who cannot tolerate or have a history of substance abuse with benzodiazepines, due to its favorable side effect profile and lack of dependence potential. When considering the treatment of GAD, it is essential to first rule out and address any underlying medical causes of anxiety, such as unrelieved symptoms or delirium, as suggested by 1. The choice of anxiolytic should be informed by the adverse effect profiles of the medications, tolerability, response to prior treatment, and patient preference, with caution warranted when considering benzodiazepines due to their risk of abuse and dependence 1.

Key Considerations for Buspirone Use

• Buspirone is typically started at a dose of 7.5 mg twice daily and gradually increased to 20-30 mg daily in divided doses, with a maximum of 60 mg daily.
• It takes 2-4 weeks to reach full effectiveness, unlike benzodiazepines which work immediately.
• Buspirone works by acting as a partial agonist at serotonin 5-HT1A receptors, modulating serotonin activity in the brain without causing sedation or dependence.
• Common side effects include dizziness, headache, nausea, and nervousness, which are usually mild and transient.

Comparison with Other Treatments

• Unlike benzodiazepines, buspirone doesn't cause withdrawal symptoms, tolerance, or physical dependence, making it suitable for long-term GAD management 1.
• The use of a stepped care model, as recommended by 1, can help tailor intervention recommendations based on variables such as symptomatology level, functional impairment, and patient preference.
• Psychological and psychosocial interventions, such as cognitive-behavioral therapy (CBT), can also be effective in treating GAD, but the evidence for these interventions is not directly related to the use of buspirone 1.

Patient Education and Support

• Patients should be informed about the delayed onset of action of buspirone to maintain treatment adherence and should take it consistently, preferably with food to enhance absorption.
• Support and education should be provided to all patients and their families about anxiety and its treatment, including information on specific symptoms or symptom worsening that warrant a call to the physician or nurse 1.

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. The efficacy of buspirone hydrochloride tablets has been demonstrated in controlled clinical trials of outpatients whose diagnosis roughly corresponds to Generalized Anxiety Disorder (GAD).

The role of Buspirone in the treatment of Generalized Anxiety Disorder (GAD) is for the management of anxiety disorder and the short-term relief of symptoms.

• Key points:
  • Demonstrated efficacy in controlled clinical trials for GAD
  • Relieves anxiety in the presence of coexisting depressive symptoms
  • Effective for short-term use, but long-term use (more than 3-4 weeks) has not been demonstrated in controlled trials 2

From the Research

Role of Buspirone in Generalized Anxiety Disorder (GAD) Treatment

• Buspirone is a nonbenzodiazepine anxiolytic used in the treatment of GAD, with anxiolytic properties similar to those of benzodiazepines and significantly better than placebo 3.
• It is particularly appropriate for patients with GAD, chronic anxiety, the anxious elderly, and those with mixed symptoms of anxiety and depression 3.
• Buspirone has been shown to be effective in reducing anxiety symptoms in patients with GAD, with significant reductions in Hamilton Rating Scale for Anxiety (HAM-A) total scores 4, 5.
• The efficacy of buspirone is similar to that of benzodiazepines, but with a slower onset of action and fewer dependency-producing aspects 3, 6.
• Buspirone has also been shown to have antidepressant effects, with significant reductions in Hamilton Rating Scale for Depression (HAM-D) scores in patients with GAD and coexisting mild depressive symptoms 5.

Dosage and Administration

• Buspirone can be administered in doses of 15-45 mg/day, with titration from 15 to 30 mg/day 4, 5.
• The efficacy and safety of buspirone have been evaluated in various dosing regimens, including twice a day (BID) and three times a day (TID) 4.
• The incidence of adverse events is similar across different dosing regimens, with the exception of a higher incidence of amblyopia in patients receiving buspirone 15 mg BID 4.

Safety and Tolerability

• Buspirone is generally well-tolerated, with a similar incidence of adverse events compared to placebo 4, 5.
• Common adverse events associated with buspirone include nausea, dizziness, somnolence, and sweating 5.
• Buspirone has a lower risk of dependency and withdrawal compared to benzodiazepines, making it a safer alternative for long-term treatment 3.