Depression buspirone

DRUG CLASSIFICATIONS Nonbenzodiadepine hypnotics Zaleplon (Sonata) zolpidem (Ambien), Schedule IV, depressants Buspirone (Buspar) Not scheduled... 

Future Outlook for Antidepressants. Third-generation antidepressants are expected to combine superior efficacy and improved safety, but are unlikely to reduce the onset of therapeutic action in depressed patients (179). Many dmgs in clinical development as antidepressive agents focus on estabhshed properties such as inhibition of serotonin, dopamine, and/or noradrenaline reuptake, agonistic or antagonistic action at various serotonin receptor subtypes, presynaptic tt2-adrenoceptor antagonism, or specific monoamine—oxidase type A inhibition. Examples include buspirone (3) (only... 

Buspirone causes less additive CNS depression than do the other antianxiety drugs. However, it is recommended that concurrent use with a CNS depressant be avoided. Buspirone may increase serum digoxin levels, which increases the risk of digitalis toxicity. 

Anxiolytics with little abuse potential, such as buspirone, and antidepressants that have a benign side-effect profile and may reduce ethanol intake warrant careful evaluation in the treatment of anxious and depressed alcoholic patients. 

Maprotiline, Moclobemide, Mianserin, Fluoxetine (Prozac), Paroxetine, Sertraline, Fluvoxamine, Citalopram, Venlafaxin (generic IR formulation and the brand Venlafaxine XR), Mirtazapine, Flupentixol-melitracen (Deanxit), Tianeptine, Extract of St. John s Wort, Buspirone Depression and anxiety... 

A therapeutic alternative for treatment of anxiety and depression is the use of 5-HT1A agonists. Azapirones comprise the major class of 5-HT1A agonists of which buspirone (Buspar [4]) is the only FDA-approved 5-HT1A selective agonist (relative to the other 13 serotonin receptor subtypes) for anxiety currently on the US market (Scheme 19.1). Buspirone has shown efficacy in randomized controlled trials of GAD for which it was approved [5-7]. Unlike benzodiazepines, buspirone is not addictive... 

Sramek, J.J., Tansman, M., Suri, A., Hornig-Rohan, M., Amsterdam, J.D., Stahl, S.M., Weisler, R.H. and Cutler, N. R. (1996) Efficacy of buspirone in generalized anxiety disorder with coexisting mild depressive symptoms. Journal of Clinical Psychopharmacology, 57, 287-291. 

Gammans, R.E., Stringfellow, J.C., Hvizdos, A.J., Seidehamel, R.J., Cohn, J. B., Wilcox, C.S., Fabre, L.F., Pecknold, J. C Smith, W.T. and Rickels, K. (1995) Use of buspirone in patients with generalized anxiety disorder and coexisting depressive symptoms. A meta-analysis of eight randomized, controlled studies. Neuropsychobiology, 25, 193-201. 

Landen, M., Eriksson, E., Agren, H. and Fahlen, T. (1999) Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors. Journal of Clinical Psychopharmacology, 19, 268-271. 

Bouwer C, Stein DJ. (1997). Buspirone is an effective augmenting agent of serotonin selective reuptake inhibitors in severe treatment-refractory depression. Souffi Afr Med J. 87(4 suppi) 534-37, 540. 

Fabre LF. (1990). Buspirone in the management of major depression a placebo-controlled comparison. J Clin Psychiatry. 51(suppl) 55-61. 

Fischer P, Tauscher J, Kufferle B, Kasper S. (1998). Weak antidepressant response after buspirone augmentation of serotonin reuptake inhibitors in refractory severe depression. Int Clin Psychopharmacol. 13(2) 83-86. 

Rickels K, Amsterdam JD, Clary C, Puzzuoli G, Schweizer E. (1991). Buspirone in major depression a controlled study. J Clin Psychiatry. 52(1) 34-38. 

Schweizer E, Rickels K, Hassman H, Garcia-Espana F. (1998). Buspirone and imipramine for the treatment of major depression in the elderly. J din Psychiatry. 59(4) 175-83. 

Miscellaneous Medications. A variety of other medications have also been used to treat depression. They have mainly been used together with an antidepressant to augment or boost its effectiveness. These augmenting medications include lithium, tri-iodothyronine (T3), buspirone, pindolol, estrogen, and anticonvulsants. 

Buspirone (Buspar). Buspirone is an anxiety-relieving medication that alters serotonin activity. When added to an antidepressant, buspirone may help treat the depression. It will also relieve anxiety and may reverse sexual side effects of a SSRl. Please refer to Chapter 5 Anxiety Disorders for more information regarding buspirone. 

When the residual depression is mild to moderate, then the risks of using lithium are probably not warranted. A less aggressive approach using a safer but less proven augmenting medication is best. The alternatives include adding T3, buspirone, pindolol, a second antidepressant, a stimulant, estrogen, or an anticonvulsant. 

Buspirone (Buspar). The first nonsedating, nonbenzodiazepine specifically introduced as an anxiolytic, buspirone is FDA approved for the treatment of GAD. This medication acts as a partial agonist at the postsynaptic serotonin (5HT)-1A receptor. Like the antidepressants, buspirone has a delayed onset of action and effectively relieves the intrapsychic symptoms of GAD. Devoid of the muscle-relaxing properties of benzodiazepines, buspirone does not as effectively relieve the physical symptoms of GAD. Buspirone is not effective in the treatment of depression. Furthermore, its utility for the treatment of anxiety disorders other than GAD appears to be limited. 

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. 

The subset of patients with GAD who do not have a comorbid depressive illness can be treated with buspirone in lieu of an antidepressant. Like the antidepressants, the buspirone treatment response is delayed by several weeks however, opting for buspirone is less likely to cause the transient exacerbation of anxiety or the sexual side effects commonly witnessed with antidepressants. Unfortunately, the usefulness of buspirone is severely limited by its requirement that it be administered two to... 

Withdrawai reactions Withdraw patients from their prior treatment gradually before starting buspirone, especially patients who have been using a CNS depressant chronically. 

Buspirone (BuSpar) [Anxiolytic] WARNING Closely monitor for worsening depression or emergence of suicidality Uses Short-term relief of anxiety Action Antianxiety antagonizes CNS serotonin receptors Dose Initial 7.5 mg PO bid T by 5 mg q2-3d to effect usual 20-30 mg/d max 60 mg/d Contra w/ MAOI Caution [B, /-] Avoid w/ severe hepatic/renal insuff Disp Tabs SE Drowsiness, dizziness, HA, N, EPS, serotonin synd, hostility, depression Notes No abuse potential or physical/psychologic d endence Interactions T Effects W/ erythromycin, clarithromycin, itraconazole, ketoconazole, diltiazem, verapamil, grapefruit juice effects W/ carbamazepine, rifampin, phenytoin, dexamethasone, phenobarbital, fluoxetine EMS T Sedation w/ concurrent EtOH use grapefruit juice may T risk of adverse effects OD May cause dizziness, miosis, N/V symptomatic and supportive... 

---