Buspirone Augmentation for SSRI-Induced Sexual Dysfunction

Evidence Quality and Limitations

The American College of Physicians rates the evidence for buspirone augmentation as low quality, meaning there is substantial uncertainty about the magnitude of benefit, with buspirone having significantly higher discontinuation rates due to adverse events (20.6%) compared to bupropion SR (12.5%; P < 0.001) in patients with depression 1, 2
The STAR*D trial found that buspirone augmentation of citalopram showed no superiority over other augmentation strategies for depression treatment, with a discontinuation rate of 20.6% due to adverse events 1, 2

There is minimal high-quality evidence specifically supporting buspirone for SSRI-induced sexual dysfunction, with the mechanism by which buspirone might help being theoretically sound, acting as a partial agonist at serotonin 5-HT1A receptors, potentially counteracting some serotonergic effects that contribute to sexual dysfunction 3

Cognitive behavioral therapy showed similar efficacy to medication augmentation in STAR*D with numerically fewer discontinuations due to adverse events (9.2% vs. 18.8% for medication groups; P = 0.086), and should be discussed as an alternative or adjunctive option 1, 2, 3
The American College of Physicians found no differences in efficacy between various switch strategies (to escitalopram, duloxetine, venlafaxine, or vortioxetine), but bupropion would typically be the preferred switch option given its significantly lower rates of sexual dysfunction compared to sertraline 1, 2, 4