Buspirone

Buspirone, sold under the name Buspar among others, is an anxiolytic medication primarily used for the treatment of generalized anxiety disorder. Unlike benzodiazepines, buspirone does not produce significant sedation, dependence, or withdrawal symptoms.

Buspirone’s principal mechanism of action involves partial agonism at postsynaptic serotonin 5-HT_1A receptors and full agonism at presynaptic 5-HT_1A autoreceptors, which initially reduces serotonergic neuron firing. Over time, autoreceptor desensitization occurs, leading to increased serotonin release and enhanced serotonergic tone, which may contribute to its clinical efficacy. It has a delayed onset of action of 2–4 weeks. Buspirone also has weak antagonistic effects at dopamine D₂, D₃, and D₄ receptors and α₁- and α₂-adrenergic receptors.

Buspirone is approved for the management of generalized anxiety disorder. It is sometimes used off-label for other anxiety disorders, as antidepressant augmentation in depression, for hypoactive sexual desire disorder in women, antidepressant-induced sexual dysfunction, and bruxism. Buspirone is not effective as a sedative–hypnotic or muscle relaxant and does not have anticonvulsant properties.

Common side effects of buspirone include nausea, headaches, dizziness, and difficulty concentrating. Serious side effects may include movement disorders, serotonin syndrome, and seizures. Its use in pregnancy appears to be safe but has not been well studied, and use during breastfeeding has not been well studied either.

Buspirone was developed in 1968 and approved for medical use in the United States in 1986. It is available as a generic medication. In 2023, it was the 40th most commonly prescribed medication in the United States, with more than 15 million prescriptions.