Can Celexa and Buspar Be Taken Together?
Yes, Celexa (citalopram) and Buspar (buspirone) can be safely taken together, and this combination is specifically recommended as an evidence-based augmentation strategy when citalopram monotherapy fails to adequately treat depression. 1
When This Combination Is Appropriate
- Start with citalopram monotherapy first at 20-40 mg daily for 4-8 weeks before considering augmentation. 1
- Add buspirone only after inadequate response to citalopram alone, not as initial combination therapy. 1
- This augmentation strategy is supported by the American College of Physicians for treatment-refractory depression. 1
Important Caveat: Bupropion Is Superior
If augmentation is needed, bupropion is the preferred choice over buspirone. 1
- Moderate-quality evidence shows bupropion decreases depression severity more effectively than buspirone when augmenting SSRIs. 1
- Bupropion causes fewer discontinuations due to adverse events compared to buspirone. 1
- However, buspirone remains a reasonable alternative, particularly for patients with prominent anxiety symptoms or when bupropion is contraindicated. 2
Safety Profile of the Combination
The combination is generally safe and well-tolerated, though theoretical serotonin syndrome risk exists. 3
- A randomized controlled trial of 119 patients found that adding buspirone to SSRIs (citalopram or paroxetine) was safe with no statistically significant difference in adverse events compared to placebo. 4
- Buspirone displays minimal sedation and lacks the abuse potential of benzodiazepines. 5
- Monitor closely for serotonin syndrome symptoms during the first 24-48 hours: tremor, diarrhea, diaphoresis, confusion, myoclonus, neuromuscular rigidity, and hyperthermia. 3
Efficacy Considerations
The evidence for buspirone augmentation is mixed. 4
- One placebo-controlled trial showed no statistically significant difference between buspirone augmentation (50.9% response) versus placebo augmentation (46.7% response) of SSRIs after 4 weeks. 4
- The high placebo response rate (46.7%) suggests the study may have been inconclusive rather than definitively negative. 4
- Low-quality evidence from guideline reviews shows no difference in suicidal ideation, serious adverse events, or discontinuation rates between bupropion and buspirone augmentation. 1
Dosing Strategy
- Buspirone dosing: Start at 5 mg twice daily and titrate up to 15-30 mg daily in divided doses based on response and tolerability. 2
- Continue citalopram at the established therapeutic dose (20-40 mg daily). 1
- Buspirone is rapidly absorbed with a short half-life of 2.1 hours, requiring twice or three times daily dosing. 5
Common Pitfall to Avoid
Do not start both medications simultaneously as initial therapy. 6