Buspar (Buspirone) Indications
Buspirone is FDA-approved for the management of generalized anxiety disorder (GAD) or short-term relief of anxiety symptoms, and should not be used for anxiety associated with everyday life stress. 1
Primary FDA-Approved Indication
Generalized Anxiety Disorder (GAD): Buspirone is indicated for patients with persistent anxiety lasting at least 1 month, manifesting as motor tension, autonomic hyperactivity, apprehensive expectation, and vigilance/scanning symptoms as defined by DSM-III criteria. 1
The drug has demonstrated efficacy in controlled trials of outpatients with GAD, including those with coexisting mild depressive symptoms. 1
Patients in approval studies had experienced symptoms for 1 month to over 1 year (average 6 months duration). 1
Duration consideration: Efficacy beyond 3-4 weeks has not been demonstrated in controlled trials, though 264 patients were treated safely for 1 year without ill effect. 1
Off-Label and Investigational Uses
Depression-Related Indications
Augmentation for major depressive disorder: Buspirone can be used to augment SSRI treatment in patients who fail initial antidepressant therapy, though it is less effective than bupropion for reducing depression severity and has higher discontinuation rates due to adverse events. 2
Antidepressant properties: Research has demonstrated antidepressant effects both as monotherapy and in combination with other antidepressants. 3, 4
Behavioral and Neuropsychiatric Uses
Agitation in Alzheimer's disease/dementia: Buspirone (5 mg twice daily, maximum 20 mg three times daily) is useful for mild to moderate agitation in elderly patients, though it may take 2-4 weeks to become effective. 2
Irritability and aggression in older adults: May be considered for managing behavioral disturbances in dementia patients. 4
Sexual Dysfunction
Hypoactive sexual desire disorder: Buspirone may be considered for premenopausal cancer survivors with low libido or lack of desire, though data are limited to noncancer populations. 2
SSRI-induced sexual dysfunction: Has been studied for treating adverse sexual effects from antidepressants. 4
Other Potential Uses (Limited Evidence)
- Research has explored buspirone for panic disorder (inconclusive results, not currently recommended), obsessive-compulsive disorder, social phobia, PTSD, and substance use disorders, though evidence remains insufficient for routine use in these conditions. 3, 5, 4
Important Clinical Caveats
Not appropriate for panic disorder: Current evidence does not support routine use for panic attacks. 3
Delayed onset: Unlike benzodiazepines, buspirone requires 2-4 weeks for full anxiolytic effect, making it unsuitable for patients requiring immediate symptom relief. 2, 3
Patient selection: Best suited for patients with chronic anxiety who can tolerate gradual symptom improvement and do not require immediate gratification. 3