MEDizzy - A 34-year-old man with mild anxiety and depression symptoms

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The central nervous system 2

A 34-year-old man with mild anxiety and depression symptoms has heard about buspirone on television and asks whether it might be suitable for him. According to the latest diagnostic criteria, the drug would be appropriate, particularly for short-term symptom control. Which of the following best describes an important property of this drug?

ExplanationBuspirone is an attractive drug for managing mild short-term anxiety. Among the reasons (and especially when compared with more traditional anxiolytics, such as benzodiazepines) are a lack of sedation (buspirone is not a CNS depressant); very little or no potentiation of the effects of other CNS depressants, including alcohol; no known abuse potential (it is not regulated by the Controlled Substances Act); or tendency for development of tolerance; and no major withdrawal syndrome. One major drawback is a slow onset of symptom relief (a week or two), and typically it takes about a month from the onset of therapy for antianxiety effects to stabilize. (Knowing this slow onset, one should resist the temptation to titrate the dosage upwards, to hasten or increase the drug’s effects, prematurely.) You should recall that long-term benzodiazepine administration is associated with withdrawal phenomena (and, depending on the use, dose, exact drug, and other patient-related factors, the syndrome can be severe). Thus, one can envisage a switch from a benzodiazepine to buspirone. Because buspirone lacks CNS depressant effects and its effects take some time to develop, one should start the buspirone several weeks before stopping the benzodiazepine and then taper the benzodiazepine dose once it’s time to stop the drug.