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Medicine Pharmacology

What is the clinical effectiveness and safety of buspirone versus benzodiazepines, serotonin reuptake inhibitors, or serotonin-norepinephrine reuptake inhibitors for the treatment of anxiety?

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This summary is based on the Rapid Response Report developed by the Canadian Agency for Drugs and Technologies in Health: Use of Buspirone for the treatment of anxiety: A review of the clinical effectiveness, safety, and cost effectiveness

Full Report (PDF)

Context
 
Generalized Anxiety Disorder (GAD) is a chronic anxiety disorder characterized by excessive, pervasive and uncontrollable worry. In the general population, GAD has a lifetime prevalence of 6%. Diagnosed twice as often in women than men, GAD typically presents as somatic illness, pain, fatigue, depression and/or sleep disturbances. Pharmacological treatments for GAD include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, anticonvulsants, benzodiazepines (BZD), buspirone, and other therapies. First-line agents include escitalopram, paroxetine, sertraline, or venlafaxine extended release (XR). Patients who have inadequate response to first-line agents after eight to twelve weeks of treatment should be considered for second-line medication. Second-line therapies include BZD, buspirone, imipramine and pregabalin. While BZD are second-line treatment, they may be used at any time if agitation or anxiety is severe.
 
Research Questions
  1. What is the comparative clinical effectiveness of buspirone versus benzodiazepines, serotonin reuptake inhibitors, or serotonin-norepinephrine reuptake inhibitors for the treatment of anxiety? 
  2. What is the comparative safety of buspirone versus benzodiazepines, serotonin reuptake inhibitors, or serotonin-norepinephrine reuptake inhibitors for the treatment of anxiety? 
  3. What is the cost-effectiveness of buspirone versus benzodiazepines, serotonin reuptake inhibitors, or serotonin-norepinephrine reuptake inhibitors for the treatment of anxiety? 

Results

The literature search yielded 102 citations with an additional two studies from the grey literature. Of these 104 reports, 10 answered the research questions and were deemed potentially relevant. Following full-text reviews, five studies met the inclusion criteria for this review.

 Key Messages

  1. There is no conclusive evidence to suggest that buspirone is more effective than BZD, SSRIs, or SNRIs. 
  2. Buspirone was associated with less drowsiness, fatigue, nervousness, depression and sleep disturbance than BZD.
  3. SSRIs and SNRIs can cause sedation, dizziness, falls, nausea, and sexual dysfunction. 
  4. No evidence was found regarding the cost-effectiveness of buspirone versus BZD, SSRIs or SNRIs for the treatment of GAD. 
 

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