Can Buspar (buspirone) be added to sertraline?

From the Guidelines

Yes, buspirone (Buspar) can be added to sertraline as a combination therapy for certain mental health conditions, but it requires careful consideration and monitoring due to potential risks of serotonin syndrome. This combination is sometimes prescribed when sertraline alone doesn't adequately control anxiety symptoms. Typically, buspirone is started at 5-7.5 mg twice daily and can be gradually increased to 20-30 mg daily in divided doses, while continuing the prescribed dose of sertraline. The combination works well because these medications act through different mechanisms - sertraline is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels, while buspirone affects both serotonin and dopamine receptors in a different way. This complementary action can enhance anxiety relief without significantly increasing side effects. However, patients should be monitored for potential serotonin syndrome, though this risk is relatively low with this particular combination, as noted in the guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. Common side effects might include dizziness, headache, nausea, or increased nervousness initially. It's essential that this combination only be used under medical supervision, as a healthcare provider needs to determine appropriate dosing based on individual patient factors and monitor for effectiveness and side effects.

Key Considerations

• The combination of buspirone and sertraline should be used with caution, especially in the first 24 to 48 hours after dosage changes, due to the risk of serotonin syndrome 1.
• Patients should be monitored for symptoms of serotonin syndrome, such as agitation, confusion, rapid heart rate, and changes in blood pressure.
• The dosage of buspirone should be started low and gradually increased to minimize side effects.
• The combination of buspirone and sertraline may be effective for anxiety relief, but the evidence is limited, and more research is needed to fully understand the benefits and risks of this combination.

Potential Side Effects

• Dizziness
• Headache
• Nausea
• Increased nervousness
• Serotonin syndrome (rare but potentially life-threatening)

Monitoring and Follow-up

• Regular monitoring of symptoms and side effects
• Adjustments to dosage as needed
• Regular follow-up appointments with a healthcare provider to assess effectiveness and safety of the combination therapy.

From the FDA Drug Label

If concomitant use of sertraline with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John’s Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including sertraline, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St John’s Wort)

Buspar can be added to sertraline, but patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases. Treatment with sertraline and any concomitant serotonergic agents, including buspirone, should be discontinued immediately if symptoms of serotonin syndrome occur 2.

From the Research

Buspar and Sertraline Combination

• The combination of buspar (buspirone) and sertraline has been studied in various contexts, particularly for the treatment of generalized anxiety disorder (GAD) and depressive disorders 3, 4.
• A study from 2010 found that both sertraline and buspirone had significant anxiolytic efficacy in elderly patients with GAD, with buspirone showing superiority over sertraline at 2 and 4 weeks, but not at the end of the 8-week study period 3.
• Another study from 2018 suggested that SSRIs, such as sertraline, are first-line treatments for GAD in adults, while buspirone is considered a second-line treatment 5.
• A 2025 study found that adjunctive buspirone therapy effectively improved anxiety symptoms in depressed patients taking antidepressants, including sertraline, with few adverse events 4.

Efficacy and Tolerability

• The efficacy of buspirone in combination with sertraline has been demonstrated in several studies, with significant improvements in anxiety symptoms and depressive symptoms 3, 4.
• The tolerability of buspirone in combination with sertraline has also been evaluated, with one study finding that adjunctive buspirone therapy was well-tolerated with few adverse events 4.
• However, another study found that sertraline was less tolerated than placebo, with a relative risk of 1.47 for dropping out due to adverse events 6.

Clinical Implications

• The combination of buspar and sertraline may be a viable treatment option for patients with GAD or depressive disorders who have not responded to monotherapy with sertraline 3, 4.
• Clinicians should consider the potential benefits and risks of adding buspirone to sertraline, including the potential for improved anxiety symptoms and the risk of adverse events 3, 6, 4.