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Other than onset of action being 2-3 weeks, why isn't buspirone used more in the treatment of generalized anxiety disorder?
Buspirone
- Thread starter grandslam521
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Given how infrequently it actually does anything for a patient, I think a better question would be why isn't it used less? I think the number-needed-to-treat is like 5.6 billion.
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Don't know the answer, but while we're at it, I was wondering if anyone had any good head to head studies of buspirone vs SSRIs.
Anectdotally several I know have attested that Buspirone does not work as well as an SSRI, though I have not seen any head to head studies to compare.
It also is not a good choice if you're trying to bridge a benzo with the treatment by starting with Buspirone & then tapering off the benzo when the Buspirone is supposed to start taking effect. There's studies showing the 2 do not work well together.
Personally I stay away from Buspirone as a first line agent for anxiety, aside from the above, and that several algorithms do not put it as a first line therapy, several patients with an anxiety disorder have a co-morbid depression or at least a few symptoms of depression. Those 2 disorders are highly linked which adds to the reasoning to start with an SSRI. I do though tend to pick Buspirone first as an augmentation agent in depression or anxiety because it is cheap & quite safer than several of the other augmentation agents in depression (e.g. lithium), and won't get your patients poked by needles as much.
(I'm starting to develop a pet peeve with psychiatrists who pick meds without factoring in the needle factor...
)
Anectdotally several I know have attested that Buspirone does not work as well as an SSRI, though I have not seen any head to head studies to compare.
It also is not a good choice if you're trying to bridge a benzo with the treatment by starting with Buspirone & then tapering off the benzo when the Buspirone is supposed to start taking effect. There's studies showing the 2 do not work well together.
Personally I stay away from Buspirone as a first line agent for anxiety, aside from the above, and that several algorithms do not put it as a first line therapy, several patients with an anxiety disorder have a co-morbid depression or at least a few symptoms of depression. Those 2 disorders are highly linked which adds to the reasoning to start with an SSRI. I do though tend to pick Buspirone first as an augmentation agent in depression or anxiety because it is cheap & quite safer than several of the other augmentation agents in depression (e.g. lithium), and won't get your patients poked by needles as much.
(I'm starting to develop a pet peeve with psychiatrists who pick meds without factoring in the needle factor...
)
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You hit the nail on the head!!!
I've heard it said that Buspar doesn't really work that well. But that's not what the Carlat report says:
Buspirone
Unfortunately, buspirone, which is as effective as any medication for generalized anxiety disorder (GAD), doesnt work for panic disorder (Acta Psychiatr Scand 1993; 88:1-11,) although one small case series found it helpful as an adjunct to benzodiazepines, which might be a nice way of avoiding the benzo dosage creep that occurs in some patients ( Am J Psychiatry 1989; 146:914-916).
Buspirone
Unfortunately, buspirone, which is as effective as any medication for generalized anxiety disorder (GAD), doesnt work for panic disorder (Acta Psychiatr Scand 1993; 88:1-11,) although one small case series found it helpful as an adjunct to benzodiazepines, which might be a nice way of avoiding the benzo dosage creep that occurs in some patients ( Am J Psychiatry 1989; 146:914-916).
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Carlat also thought it was cute when Biederman said he was one rank below God about two weeks ago. Just saying.
Which isn't to say I don't usually love the Carlat report, because I do. But it certainly has its limitations.
I am the first to bash inappropriate influence of drug companies on medical practice, and that's one reason I have come to enjoy the Carlat report.
I would love to be a Biederman hater. However, my own mother worked at MGH for years and she thought the world of him. She said he was a miracle worker with severely ill children.
Of course, this has nothing to do with Buspar.
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Carl Salzman at Mass Mental always said "Buspar is everything you'd want in a drug except efficacy."
Funny, about twenty seconds ago I read in CNS Spectrums a piece by Baldwin on the tx of GAD: "A recent effect-size analysis of pharmacologic treatments for GAD found an overall mean effect size at 0.39, with some differences between medication class: pregabalin .50; antihistamines (hydroxyzine) .45; SNRI .42; benzodiazepines .38; SSRI .36; and azapriones (buspirone) .17."
The citation is: Hidalgo RB, Tupler LA, Davidson JR. An effext-size analysis of pharmacologic treatments for generalized anxiety disorder. J Psychopharmacol. 2007;21(8);864-872.
ouch
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Solely from a patient perspective it just made me dizzy about 20-30 minutes after ingestion and did little else.
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Is it ok to prescribe Buspirone and Adderall together?
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If this is true, why isn't Lyrica used for anxiety more in the US? I've read it's commonly used for anxiety in Europe, and some people on the benzo forums say it helps them to withdraw much more quickly than they could otherwise. Others say that then getting off Lyrica itself is a bear, but not as bad as typical benzo withdrawal.
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I was told by a pharma researcher, "It has everything but efficacy." It looks good on paper, but I haven't seen a great clinical response in most patients.
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Isn't it in the NICE treatment guidelines for anxiety? At least I think it was one year ago.
I've never seen Lyrica used for anxiety and have never used it. I have used gabapentin, which is becoming increasingly popular in the addiction field, even though both lyrica and gabapentin are potential drugs of abuse. I agree that it's unclear why one would use Lyrica and not gabapentin -- I'm guessing if used in Europe it has something to do with formularies or something like that.
As for buspirone, I have had some patients report benefit from it, although I suspect the placebo effect might be the bigger key there. I think the idea that it doesn't work is more anecdotal than anything else, right? It seems to be a truism everyone follows, which makes me suspect it might not be true. Any studies other than the one referenced above?
what kind of effects do abusers get from gabapentin
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I once heard of a psychiatrist who was thrown off the Astra Zeneca and the Bristol Meyers Squib speaker’s panel by saying: “Seroquel is the Buspar of antipsychotics” during his question and answer session. It seems Astra Zeneca didn’t like the comparison, and BMS didn’t like their product being used as a derogatory.
Patient’s don’t like Buspar because Benzos work first pill and they can tell it is doing something. However, Buspar looks like it does something in blinded control trials. We used to call it psychiatry’s example of a drug in search of an illness. In STAR-D, it was comparable to Li+ and T3 as an augmentation strategy.
My favorite indication is to use it to make your depressed patients feel like you are taking them seriously when they push you to interrupt an antidepressant trial prematurely. It seems to do no harm, and if you add something more active you will never know if that was why a patient got better. I can only think of once when someone crashed and burned after I took Buspar back off.
Patient’s don’t like Buspar because Benzos work first pill and they can tell it is doing something. However, Buspar looks like it does something in blinded control trials. We used to call it psychiatry’s example of a drug in search of an illness. In STAR-D, it was comparable to Li+ and T3 as an augmentation strategy.
My favorite indication is to use it to make your depressed patients feel like you are taking them seriously when they push you to interrupt an antidepressant trial prematurely. It seems to do no harm, and if you add something more active you will never know if that was why a patient got better. I can only think of once when someone crashed and burned after I took Buspar back off.
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Wow, years since this thread's been on and missing Doc Samson who always was chock full of good knowledge and balance.
Buspirone has never worked well whenever I'd tried it as a first-line and I gave up on it for it's use in that manner. Again I don't see studies showing it's worse because I guess no one's done any. Most FDA approved meds are just that-they work better vs placebos but there isn't data showing how it compares with others.
Buspirone, however, does have data showing it does work well as an SSRI augmentation medication and I've had a lot of success with it for augmentation. It's become a new pet-peeve for me to see everyone giving out Abilify as an augmentation agent when it's hundreds of $$$ a month when buspirone is only $4.
Buspirone has never worked well whenever I'd tried it as a first-line and I gave up on it for it's use in that manner. Again I don't see studies showing it's worse because I guess no one's done any. Most FDA approved meds are just that-they work better vs placebos but there isn't data showing how it compares with others.
Buspirone, however, does have data showing it does work well as an SSRI augmentation medication and I've had a lot of success with it for augmentation. It's become a new pet-peeve for me to see everyone giving out Abilify as an augmentation agent when it's hundreds of $$$ a month when buspirone is only $4.
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with the exception of STAR*D the data for buspirone augmentation of an SSRI is not convincing. The NICE guidelines for depression specifically state that buspirone augmentation is not recommended. although i'm not thrilled about SSRI augmentation of atypicals there is quite a bit of data for different antipsychotics that supports this practice. unfortunately this fad postdates STAR*D and we don't have head-to-head comparisons with other drugs. though of course i agree with you about considering cost issues.
lithium and T3 have evidence for augmentation specifically for TCAs (and to a lesser extent MAOIs) - there is not much supporting their addition to SSRIs.
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I have some attendings that claim "it works, you just have to use it at supratherapeutic doses."
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It can make people feel calm or potentially euphoric. From what I understand, the abuse issue is bigger is settings where people don't have access to better things, so jails and treatment centers. I have talked to providers who have had patients take way more than the prescribed amounts or hoard and then overtake gabapentin, so yeah, there's something happening.
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One reason for its popularity in inpatient addiction centers, especially among the court-ordered population, is that cheapo urine drug tests performed on site are not going to detect gabapentin. Many of these facilities are somewhat reluctant to pay for actual gas chromatography of all of the urine samples that they generate, though some in my area are starting to do so due to the prevalence of gabapentin abuse in their treatment populations.