Buspirone long-term effects

There are two principal disadvantages of buspirone therapy. First, it must be administered two or three times daily. Long-term patient compliance is notoriously poor for medications that cannot be administered in a single daily dose. Second, buspirone is not an effective treatment for depression or any of the other comorbidities that frequently accompany GAD. As a result, buspirone monotherapy is only an alternative for GAD patients who have no comorbid illness. 

Buspirone is well-tolerated, with the main side-effects being dizziness, anxiety, nausea and headache. It is tolerated by the elderly (Bohm et al. 1990). It does not cause sexual dysfunction and does not appear to be associated with a discontinuation syndrome. Overdose causes drowsiness but there are no reports of serious toxic effects. A potential for interaction with drugs that inhibit the CYP450 3A4 isoenzyme is not a significant problem in cHnical practice. GAD is usually a chronic condition and buspirone is suitable for long-term treatment. Patients should be advised to expect a slow onset of benefits and be reviewed regularly in the early stages of treatment. 

Another alternative is buspirone, a non-benzodiazepine anxiolytic that seems to be free of untoward effects on cognitive performance (Ninan et ul., 1998). As indicated in Chapter 1, the anxiolytic effect of this compound ma take a few weeks to occur (and is often rather weak), meaning that buspirone is better suited for long-term treatment of anxiety syndromes than for immediate anxiolvsis. 

While buspirone does not interact with brain BZD receptors, it has been shown to be superior to placebo and as effective as BZDs for GAD ( 45, 46, 47 and 48) (Table 12-3). In a long-term follow-up study of chronic GAD patients who participated in a 6-month trial comparing clorazepate and buspirone, Rickels and Schweizer ( 33) found a nonsignificant trend for former buspirone-treated patients to report less anxiety than former clorazepate-treated patients. In addition, whereas 65% of the former clorazepate-treated group were still taking anxiolytic medication at 40-month follow-up, no former buspirone patient was taking a psychotropic. 

Other than slow taper, no consistently effective treatment to alleviate withdrawal symptoms has been reported. Although several compounds have been studied (e.g., b-blockers, clonidine, carbamazepine, abercamil, ondansetron), results have been contradictory ( 250). Carbamazepine, however, may be useful in seizure-prone patients (251). Valproate (VPA) has also been reported to benefit patients undergoing BZD discontinuation after long-term dependence ( 252), which may be related to VPA s potential anxiolytic properties, its ability to alleviate withdrawal phenomena, or both. The azaspirone anxiolytic buspirone has been reported ineffective in suppressing withdrawal symptoms, particularly in long-term BZD users (253, 254). Hydroxyzine has also been found beneficial in treating patients for lorazepam withdrawal (255). 

Because of the lack of dependency and tolerable adverse effect profile, antidepressants have emerged as the treatment of choice for the long-term management of chronic anxiety, especially in the presence of comorbid depressive symptoms. Buspirone is an additional anxiolytic option (Table 69-7) in patients without comorbid depression or other anxiety disorders (e.g., panic disorder and SAD). Because of the high risk of adverse effects and toxicity, barbiturates, antipsychotics, antipsychotic-antidepressant combinations, and antihistamines generally are not indicated in the treatment of GAD. The benzodiazepines are more effective in treating the somatic and autonomic symptoms of GAD as opposed to the psychic symptoms (e.g., apprehension and worry), which are reduced by antidepressants. ... 

Smiley A, Moskowitz H. Effects of long-term administration of buspirone and diazepam on driver steering control. Am JMed 9%6) 80 (Suppl 3B), 22-9. 

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