SSRIs / SNRIs + Buspar

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Hey folks,

I was wondering if I could get your expert perspective on augmentation strategy in respect to using either an SSRI or SNRI and that of : Buspar.

Looking up either of these drug-drug combinations, I see that this has the potential to result in : Serotonin syndrome.

What sort of informed consent discussion do you have with the patient in regards to the above issue ? Specifcally : what probability do you quote in regards to Serotonin occurring ? Is it even possible to give such a probability ?

I have never attempted either of the above regimens, although I am familiar with SS in regards to other meds ( and know it is rare in this sphere - i.e. triptans, SSRIs, SNRIs, opioids, etc.).

Thanks.

I haven't recently read the FDA package inserts but they usually give the breakdown of odds of getting what side effect.

I've never had anyone have SS from Buspirone though I always prescribed it within the manufacturer's guidelines. I've had tremendous success with it as an augmentation agent. By itself it doesn't do much, but when adding it to an already working SSRI or SNRI where there isn't complete resolution of symptoms, yes it's been quite effective.

Originally Posted by whopper

I haven't recently read the FDA package inserts but they usually give the breakdown of odds of getting what side effect.

I've never had anyone have SS from Buspirone though I always prescribed it within the manufacturer's guidelines. I've had tremendous success with it as an augmentation agent. By itself it doesn't do much, but when adding it to an already working SSRI or SNRI where there isn't complete resolution of symptoms, yes it's been quite effective.

Thanks for the feedback, much appreciated.

Given that this is a rare potential complication, do you obtain informed consent with this medication combination ?

The standard is to inform about what the common man would want to know, which is that which is common and that which is life threatening. So I try to address SS if there's a risk. What qualifies as "common" is more subjective, of course.

I woudln't get informed consent any more than any other med. Every med requires that the patient give consent and we discuss on a reasonable level the side effects. I often times present it to the effect of...

"You shouldn't have any problems, but they can happen. The only way we'll know if this med works on you is if we try it. The scientific data suggests it'll work on you, the odds are in your favor, but it might not. Side effects can happen, but please don't take this expecting them to happen because they are unlikely. If you have a terribly bad side effect where you know you will not be able to tolerate this medication, call me, call emergency services or stop the medication if you're still at the starting dosage, or taper it down to the previous dosage. If you have a minor side effect, one you're willing to deal with for the benefits don't stop it but keep note of it and let me know. Sometimes these meds cause minor side effects that just go away in a few days after starting it."

I then tell patients, if they want the long, drawn out, extremely detailed version, I'll print them out a handout, otherwise if they want the abbreviated, most likely what bad stuff can happen, I'll go through that.

The Buspirone + SSRI combination is not the type of thing where it's something to worry about on the degree like giving lithium.

I view it as just a sequential increase in their serotonin that if increased too fast, just like someone on only 1 SSRI but the dosage is being increased.

Everything in medicine, when new, is scary. I only treated about a handful of patients on Clozaril in residency. In a forensic unit, I always had a handful of patients on Clozaril. After 6 months of it, I was no longer scared by it. I remember the first time I prescribed Librium...I was freaking out.

That's not to invalidate your concern. I'd still be scared or at least hesitant in doing something new, but that's the only way we're going to grow in this profession.

Originally Posted by whopper

I woudln't get informed consent any more than any other med. Every med requires that the patient give consent and we discuss on a reasonable level the side effects. I often times present it to the effect of...

"You shouldn't have any problems, but they can happen. The only way we'll know if this med works on you is if we try it. The scientific data suggests it'll work on you, the odds are in your favor, but it might not. Side effects can happen, but please don't take this expecting them to happen because they are unlikely. If you have a terribly bad side effect where you know you will not be able to tolerate this medication, call me, call emergency services or stop the medication if you're still at the starting dosage, or taper it down to the previous dosage. If you have a minor side effect, one you're willing to deal with for the benefits don't stop it but keep note of it and let me know. Sometimes these meds cause minor side effects that just go away in a few days after starting it."

I then tell patients, if they want the long, drawn out, extremely detailed version, I'll print them out a handout, otherwise if they want the abbreviated, most likely what bad stuff can happen, I'll go through that.

The Buspirone + SSRI combination is not the type of thing where it's something to worry about on the degree like giving lithium.

I view it as just a sequential increase in their serotonin that if increased too fast, just like someone on only 1 SSRI but the dosage is being increased.

Everything in medicine, when new, is scary. I only treated about a handful of patients on Clozaril in residency. In a forensic unit, I always had a handful of patients on Clozaril. After 6 months of it, I was no longer scared by it. I remember the first time I prescribed Librium...I was freaking out.

That's not to invalidate your concern. I'd still be scared or at least hesitant in doing something new, but that's the only way we're going to grow in this profession.

Thanks again for the information.

I will certainly be using this combination for pts with GAD or MDE, rather than an antipsychotic augmentation agent ( which I haven't done as yet). Buspar's side effect profile is close to nil.

Originally Posted by ghost dog

Hey folks,

I was wondering if I could get your expert perspective on augmentation strategy in respect to using either an SSRI or SNRI and that of : Buspar.

Looking up either of these drug-drug combinations, I see that this has the potential to result in : Serotonin syndrome.

What sort of informed consent discussion do you have with the patient in regards to the above issue ?

Nothing besides the usual.......that combination has been tried god knows how many times(millions I'd guess?), mostly by pcps.......