Welcome to Bipolar Medication Spotlight, where we shine the light on medications used to treat bipolar disorder and other symptoms often related to bipolar disorder. Two weeks ago, we covered the benzodiazepines (or benzos for short) – a class of powerful and fast-acting anxiolytics (tranquilizers) used to calm the nerves in the midst of a panic attack. This week, we turn our attention to a gentler anxiolytic – BuSpar (buspirone).

BuSpar is an anti-anxiety agent that is not a benzodiazepine or barbiturate and therefore does not have the same risks of dependency and sedation. It works on the serotonin system differently than the SSRI antidepressants do and is very well tolerated (minimal side effects), but it is not clear how effective it is when given alone without another agent, such as an antidepressant. It must be taken several times a day and cannot be taken “as needed” as the benzos can. It must build up in the system to have an effect, and this can take several weeks.

Potential Benefits

BuSpar is primarily used to treat various symptoms related to treat general anxiety disorder (GAD). Because it’s not as powerful as the benzodiazepines, it’s generally less effective in treating severe forms of anxiety, panic disorders, and obsessive-compulsive disorders. BuSpar is sometimes useful in treating symptoms of general anxiety, including…

• Excessive worry or anxiety that can’t be controlled through therapy
• Feelings of restlessness or edginess
• Difficulty concentrating
• Irritability
• Muscle tension
• Difficulty falling asleep or staying asleep
• Fatigue – feeling run down

Potential Negative Side Effects

BuSpar has a fairly mild side effect profile and is generally well-tolerated. Common side effects include the following:

• Diziness or light-headedness, especially when the medication is first started
• Drowsiness
• Fatigue
• Dry mouth
• Increase in nightmares or dreams

Less common but more serious side effects include the following:

• Allergic reaction – hives or edema (swelling of the lips, tongue, or face) or difficulty breathing or swallowing
• Irregular heartbeat or chest pain
• Headache
• Slurred speech
• Confusion
• Blurred vision
• Numbness or tingling in the hands, arms, feet, or legs
• Depression
• Uncontrollable movements of the arms, legs, tongue, or lips

If you’re switching to BuSpar from a benzodiazepine, you may experience some additional side effects related to withdrawing from the benzodiazepine, including irritability, agitation, anxiety, insomnia, tremors, or seizures.

Remember: BuSpar may take several weeks or to become fully effective, so don’t expect to start feeling better immediately. Also, side effects tend to fade and often disappear after several days. Patience is important, but if you have any concerns about how you are feeling, contact your doctor. You will most likely have a follow-up visit with your doctor within a month or less of starting the medication; this is a good time frame for checking in to see if benefits have started or whether side effects have faded or persisted.

BuSpar in My Practice

I have not used BuSpar much in my practice in recent years, because it doesn’t seem to work particularly well, especially on its own. The primary way I would use it would be as an add-on to an agent such as an SSRI antidepressant that was having some benefit but not enough. It can also be useful in someone who is at high risk of developing addiction or dependency to medications but still needs some reduction in anxiety symptoms – but again its inconsistent effectiveness and the need to take it multiple times per day makes it a less attractive choice most of the time.

If you’ve taken any BuSpar or are a doctor who has prescribed it, please post a comment to share your experiences and insights. If you’ve taken the medication, include specifics on why you were prescribed it and how you felt when taking it. Did it help or not? Did it do more harm than good?

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    Last reviewed: 25 Sep 2009