Review Question - QID 101713

Buspirone is an acceptable adjunctive agent for Generalized Anxiety Disorder (GAD) that acts as a selective agonist at 5HT-1A serotonin receptors.

Buspirone is useful as an adjunctive treatment in patients who experience a partial response to first-line treatment with a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI). It is also useful in patients who have a history of drug abuse with anti-anxiety medications, as dependence does not occur with chronic buspirone therapy. The response to buspirone typically does not occur until after several weeks of daily use. Buspirone lacks both anticonvulsant and muscle relaxant side effects which makes it quite different from benzodiazepines.

Gliatto reviews the diagnosis and management of GAD, concluding that benzodiazepines are useful for short-term treatment. However, because GAD is often chronic in nature, additional pharmacotherapy such as buspirone or antidepressants are frequently used in management of the disorder as well.

Chessick et al. conducted a meta-analysis evaluating the use of azapirones (such as buspirone) in the treatment of generalized anxiety disorder. They find that buspirone is useful in the treatment of GAD; however, it is likely not significantly more effective than benzodiazepines. The authors also conclude that the side effects of buspirone therapy are mild and non-serious.

Illustration A depicts the agonist action of buspirone at post-synaptic 5HT-1A receptors.
Illustration B contains a chart showing the most common medications used in the treatment of anxiety disorders; note that buspirone is most effective for GAD.

Incorrect answers:
Answer 1: Benzodiazepines act on the GABA receptor; important side effects of benzodiazepines include sedation, muscle-relaxant effects, and increased seizure risk with abrupt withdrawal.
Answer 2: Clonidine is a central alpha-adrenergic agonist used off label for opioid withdrawal and nicotine dependence, but clonidine is not used for GAD.
Answer 3: Agents active at glycine receptors include caffeine and strychnine (both antagonists); neither are used for GAD.
Answer 5: Beta adrenergic antagonists (for example propranolol) can be used for situational anxiety, but are not first-line therapy for GAD.