Buspirone Augmentation in Treatment-Resistant Depression

Introduction to Buspirone Augmentation

• The American College of Physicians reports low-quality evidence from the STAR*D trial showing no difference in response or remission rates when augmenting citalopram with buspirone compared to other augmentation strategies, though buspirone had significantly fewer discontinuations due to adverse events (12.5%) versus other options (20.6%; P < 0.001) 1

Clinical Guidelines for Buspirone Use

• The American Academy of Family Physicians guidelines recommend second-generation antidepressants (SSRIs, SNRIs) as first-line therapy for major depression, and buspirone should not be used as monotherapy for major depression 2, 3

Advantages and Considerations

• Buspirone has no addiction potential, tolerance, or cognitive impairment unlike benzodiazepines, making it safer for long-term use 4
• Buspirone has a lower discontinuation rate due to adverse events (12.5%) compared to other augmentation strategies (20.6%) 1
• Buspirone targets different neurotransmitter systems than SSRIs (5-HT1A partial agonist versus serotonin reuptake inhibition) 4

Dosing and Monitoring

• Start buspirone at 5 mg twice daily and titrate to 10-30 mg twice daily (maximum 20 mg three times daily) 4
• Allow 2-4 weeks for full therapeutic effect and assess for serotonin syndrome risk in the first 24-48 hours after initiation or dose changes 4