Can BuSpar (buspirone) activate increased depression and worsen sleep difficulties?

Can BuSpar Activate Increased Depression and Worsen Sleep Difficulties?

Yes, BuSpar (buspirone) can potentially worsen sleep difficulties and may activate increased depression in some patients. According to the FDA drug label, insomnia is reported as an adverse effect in 3% of buspirone patients compared to 3% of placebo patients, and depression is reported in 2% of buspirone patients compared to 2% of placebo patients 1.

Effects on Sleep

Buspirone lacks sedative properties and may actually have stimulant-like effects on sleep:

• Research shows buspirone can increase wake time after sleep onset, with a marked and significant increase observed on the first night of administration 2
• Studies indicate buspirone increases sleep latency (time to fall asleep) and decreases total sleep time through reductions in both non-REM and REM sleep 3
• Clinical guidelines specifically note that buspirone is "useful only in patients with mild to moderate agitation" and "may take 2 to 4 weeks to become effective" 4
• Unlike benzodiazepines, buspirone lacks hypnotic properties and has been termed "anxioselective" 5

Effects on Depression

Buspirone's relationship with depression is complex:

• The FDA drug label lists depression as a treatment-emergent adverse experience occurring in 2% of buspirone patients (equal to placebo) 1
• Dream disturbances are listed as a "frequent" adverse event, while dysphoria is listed as an "infrequent" adverse event 1
• Some research suggests buspirone may actually have antidepressant properties when used as augmentation therapy for severe depression with SSRIs 6, 7
• However, individual responses vary significantly, and the drug can potentially worsen depressive symptoms in some patients

Clinical Considerations

When prescribing buspirone, consider:

1. Sleep impact assessment: Monitor for increased sleep latency and decreased sleep quality, especially during the first few nights of treatment

2. Depression monitoring: Assess for any worsening of depressive symptoms, particularly during the initial weeks of treatment

3. Timing considerations:

   • Administering buspirone earlier in the day rather than at bedtime may minimize sleep disruption
   • The full anxiolytic effect may take 2-4 weeks to develop 4

4. Alternative options: For patients with anxiety and concomitant sleep difficulties, buspirone may have "limited usefulness" 2, and other medication options may be more appropriate

5. Dosage factors: Initial dosage recommendations are 5 mg twice daily, with maximum dosage of 20 mg three times daily 4

Important Caveats

• Individual responses to buspirone vary considerably
• The stimulant-like effects on sleep appear to be more pronounced during initial administration
• Patients should be informed about potential sleep disruption before starting treatment
• If sleep difficulties or depressive symptoms worsen significantly, medication should be reassessed

For patients with both anxiety and sleep problems, cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line treatment according to the American College of Physicians 4, with pharmacological options considered only if CBT-I alone is unsuccessful.