Use of Buspirone in Patients with Generalized Anxiety Disorder and Coexisting Depressive Symptoms

Abstract

This report presents the results of a retrospective analysis of pooled efficacy data from eight studies in which buspirone was compared to placebo in 520 patients with generalized anxiety disorder (GAD). In addition to evaluating overall efficacy in the composite patient data base, four criteria were used to identify subsets of patients with GAD who had coexisting depressive symptoms of at least moderate intensity: (1) a score of ≧ 2 on the Hamilton Anxiety (HAM-A) Rating Scale item 6 (depressed mood), (2) a score of ≧ 2 on the Hamilton Depression (HAM-D) Rating Scale item 1 (depressed mood), (3) a HAM-D total score of ≧ 18, or (4) a HAM-D Retardation Factor value (items 1,7,8, and 14) greater than the median for the group. Overall, patients treated with buspirone demonstrated significant (p ≤ 0.001) improvement over baseline in total HAM-A scores compared to patients who received placebo. Buspirone also produced significant (p ≤ 0.001) global improvement compared to placebo as assessed by the attending physician. Of the GAD patients stratified according to the four criteria for coexisting depressive symptoms, a substantial percentage (44-64%) of the total patient sample exhibited significant depressive symptoms as part of their anxiety disorder. Patients with GAD and coexisting depressive symptoms of at least moderate intensity exhibited significantly greater improvement with buspirone compared to placebo treatment regardless of the stratification criterion used. They also responded at least as well or better to buspirone therapy as did those with GAD who had less intense depressive symptoms. Weekly ratings indicated that buspirone produced a progressively increasing anxiolytic response relative to placebo throughout the 4-week double-blind treatment period. These findings indicate that buspirone is an effective anxiolytic for patients with GAD who experience coexisting depressive symptoms regardless of the intensity of those symptoms.

Tratamento farmacológico do transtorno de ansiedade generalizada: perspectivas futuras

“…12,23 Mais ainda, estudo de metanálise sugere que a buspirona seria eficaz em pacientes com TAG com sintomas depressivos. 25 No entanto, tem como desvantagem um início de ação mais demorado, precisando de cerca de duas semanas de administração para que surjam os primeiros efeitos benéficos. Como sua meia-vida de excreção varia de duas a oito horas, deve ser administrada três vezes ao dia.…”

“…A buspirona também atuaria nos sintomas depressivos associados ao TAG. 25 Outra diferença entre os tratamentos disponíveis estaria associada ao tipo de sintomatologia ansiosa, pois alguns estudos sugerem que os benzodiazepínicos, que seriam mais eficazes nos sintomas somáticos e autonômicos, seriam relativamente menos eficazes no tratamento de sintomas psíquicos do TAG (tensão, apreensão e preocupação) quando comparados aos AD. 14,15,31 Existe também a indicação de que, em longo prazo, haveria uma superioridade dos ADT em relação aos BZD.…”

Effective Recognition and Treatment of Generalized Anxiety Disorder in Primary Care

“…Higher cortical activity, in turn, stimulates other portions of the brain resulting in physiologic responses and consequent somatic sensations (Figure 1). 5 The somatic sensations are what drive many patients into primary care offices: heart palpitations, hyperven-ders tend to be highly comorbid, and patients frequently suffer from multiple anxiety disorders. For example, in an ongoing longitudinal naturalistic study 15 of anxiety disorders in the primary care setting, 36% of patients with GAD had 1 other anxiety disorder, 14% had 2 others, and 4% had 3 others.…”

“…Buspirone is a serotonin-1A (5-HT 1A ) partial agonist, which is mechanistically different from other anxiolytics. Studies 4,5 have found buspirone to be superior to placebo in the treatment of GAD and mild depressive symptoms. Buspirone has recently become available in generic formulations.…”

Selective serotonin reuptake inhibitors in the treatment of generalized anxiety disorder

“…An early study established that buspirone had comparable efficacy with diazepam in patients with generalized anxiety and a meta-analysis of eight controlled treatment studies indicates that buspirone has comparable efficacy with benzodiazepines in the management of GAD [42,43]. It also appears efficacious in reducing associated depressive symptoms in patients with GAD, but is not an accepted treatment for patients with major depression [44].…”