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Buspirone is sometimes prescribed for mild anxiety that does not respond to the first line of treatment medications. It has less side effects than other anxiety-reducing medications although it can take longer to work.

We will all experience stress and some symptoms of anxiety during our lives and this is perfectly normal, even adaptable. Anxiety is an emotion and so can be experienced in varying degrees of intensity by different people. At one end of the spectrum it is normal and helps us to function; at another it can be extremely maladaptive and result in considerable distress for the sufferer.

It is duration, intensity, and frequency that separate normal, functional anxiety from abnormal, pathological anxiety. Abnormal anxiety is where it has become disproportionate to the scenario that led to the feelings of anxiety; it is regarded as pathological anxiety when the intensity, duration, and/or frequency of anxiety are such that it the level of distress and chronicity means it has a significant impact on a person's daily functioning. This distinction is important as it is the impact on a person's life that moves anxiety to a disorder.

Anxiety can be an unbearable condition. People often reach the point where they would do anything not to feel a constant sense of fear, agitation and anticipation. The physical side effects are draining and the intrusive thoughts and constant rumination exhausting. In the long term, psychotherapy and other holistic approaches are the only way you can rid yourself of your anxiety for good but what do you do in the short-term when you just need a break?

In these cases medication can prove extremely helpful. However, anxiety disorders are complex problems that cannot be solved simply. Many people seek a fast and easy cure through medication but sadly there no “magic pill”. Medications need to be taken within this context. They can be beneficial in the short term and as an adjunct to psychological therapies but in themselves they are not the solution, even when very effective at temporarily removing discomfort. Medication works at a superficial level by dampening down the physiological (or in some cases, depending on the medication, cognitive) symptoms of anxiety, but they don’t deal with the underlying emotional issue which needs to be otherwise addressed.

Buspirone is one medication that is sometimes prescribed to alleviate some of the physical sensations of anxiety. Buspirone is in a class of medications called anti-anxiety medications, which otherwise primarily consist of benzodiazepine drugs such as diazepam etc.

Buspirone is a “second line” therapy after selective serotonion reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). They are prescribed for the short-term relief of anxiety symptoms or in anxiety disorders. Buspirone is said to promote mental clarity and reduce anxious thoughts. As it is a mild sedative and is intended to promote relaxation, it is also expected to improve agitation and irritability, as well as reducing some other physiological anxiety symptoms. Generally it is recommended for mild anxiety but is also thought to be especially useful for older people, as it is probably less likely to cause psychomotor issues that might increase the risk of falls.

Mechanism of action

Buspirone is from the azapirone class of medications and is thought to act on specific serotonin and dopamine receptors, although more specifically on serotonin receptors. It is typically used as an adjunct to other medications such as anti-depressants, which can often take quite a long time to have an effect and can often increase anxiety symptoms in the first instance.

The negative aspect of buspirone is that it is slow-acting — response to treatment may take up to two weeks, unlike benzodiazepines, which are fast-acting. This can be off-putting as a person with severe anxiety wants the anxiety to stop as soon as possible, not least so that they are able to sleep.

The dependence and abuse potential of buspirone hydrochloride is believed to be low; however it is only licensed for short-term use; and anecdotal reports suggests that the potential is definitely there. As it has a mild sedative quality, this can always be habit forming. Its main advantage is that it has few side effects, does not tend to affect cognitive performance.

Common side effects include:

  • Nausea
  • Headaches
  • Dizziness
  • Drowsiness
  • Feeling light-headed

Rare/serious side effects include:

  • Weight or appetite changes
  • Fainting
  • Hypo or hypertension
  • Muscle spasms or cramps
  • Eye irritation
  • Allergic reactions

When taken in conjunction with alcohol, it is reported to result in a strongly narcotic effect and each is said to heighten the effect of the other. It is also said to have the potential to interact with numerous medications including monamine oxidase inhibitors (MAOIs), blood thinners such as warfarin, and medications that affect liver enzymes such as the antibiotic erythromycin.

Studies to support the efficacy and benefit of buspirone are limited. Neither of the two controlled trials of the drug in social anxiety disorder were able to demonstrate its effectiveness when used on its own. Where studies have found a benefit, it appears to be with higher doses, which significantly increases side effects such as headaches and nausea. Furthermore, a recent meta-analysis found no conclusive evidence to suggest that buspirone is more effective than benzodiazepines, SSRIs, or SNRIs, although it is associated with less sedation, tiredness, nervousness, low mood, and sleep disturbance, than benzodiazepine medications.

Therefore the use of buspirone seems largely unsubstantiated, surprising given its use as a second line of treatment. However, it is probably liked by prescribers as the associated risks and side effects are reportedly less than other medications available to patients.

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