Does Buspar (Buspirone) Work Right Away?

In our latest question and answer, our pharmacist discusses several points regarding Buspar, including when you can expect it to start working.

Question

I was told by my primary care doctor that Buspar would be a good fit for me because it works immediately and can be taken only when needed, be it once a day, a couple of times a week, every day, a few times a month, etc. She also said there aren't any withdrawal symptoms. I can safely take 1/2 alprazolam for feelings of panic, but I wanted some additional support as that tends to just make me sleepy. I want to be functional and venture back out again. After reading about Buspar on this site, it seems she was inaccurate about sporadically taking it to be helpful. Can you clarify the specific way in which it needs to be taken to be beneficial, please? Is there an herbal supplement that I could start with rather than jumping into another prescribed option? If I try the prescribed route, do compound pharmacies offer cleaner versions of Buspar?

Asked by I Wonder If On Mar 27, 2023

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Mar 27, 2023
Last updated Mar 29, 2024

Key points

  • Buspar is a medication that is not effective immediately and is not intended to be used as an "as needed" medication.
  • It has a gradual onset of action and can take up to 4 weeks to show its full effect. It is important to consistently take Buspar to achieve its therapeutic effect.
  • Buspar is different from benzodiazepines because it is used for the long-term management of anxiety disorders and has a lower potential for dependence and withdrawal.
  • Herbal remedies for anxiety such as Ashwagandha, Kava, Valerian, Gingko, and Passionflower may have a place in therapy for certain individuals hoping to treat anxiety symptoms but their efficacy and safety cannot be reliably determined due to a lack of evidence for their benefit, and a lack standardization and quality control in their production.

Answer

Thanks so much for reaching out! I'm happy to help answer this for you.

When Does Buspar Start Working?

You are correct in saying that Buspar (buspirone) does not work right away, and is certainly not intended, nor is effective, as an 'as needed' anxiety medication. This is very unlike benzodiazepines, like alprazolam, which can be used intermittently.

Although the onset of action of Buspar can vary by individual, in clinical trials, improvements in anxiety symptoms are generally seen within the first week of treatment, with further improvement seen over the course of several weeks.

One large study reviewing the pharmacotherapy of anxiety disorders, published in the journal 'Frontiers in Psychiatry', stated the following:

Buspirone is generally dosed two to three times a day and has a gradual onset of action of around 10 days to 4 weeks.

Front Psychiatry . 2020 Dec 23;11:595584

Other studies have reported similar findings, that it takes at about a week or so of consistent dosing to realize the effects of the drug.

Why Doesn't Buspar Work Right Away?

As mentioned, Buspar does not work immediately when you first start taking it, unlike some other drugs used for anxiety, like benzodiazepines. This is simply due to how Buspar works.

Buspar works by modulating the activity of serotonin and dopamine neurotransmitters in the brain, similar to some antidepressants, which take time to produce a therapeutic effect.

Since it typically takes one or several weeks for Buspar to reach its full therapeutic effect, it can be frustrating for those who are looking for immediate relief from their anxiety symptoms.

However, once Buspar has reached its full effect, it can be an effective long-term treatment for anxiety disorders (although it must be noted that there aren't many studies that have evaluated the long-term effects of Buspar use).

How Should Buspar Be Dosed?

Since Buspar is not effective as an 'as needed' medication, it is recommended to be dosed consistently in order for it to have a therapeutic effect. In other words, you can't just take Buspar when you feel like you need it. It doesn't work that way.

The recommended initial dose of Buspar is 10-15 mg daily (5 to 7.5 mg in two daily doses).

The initial dose can be gradually increased by 10 mg every one to two weeks, up to a maximum dose of 60 mg per day.

When the medication is titrated at this relatively slow pace, it is usually well-tolerated.

Most sources recommend that individuals give the medication a trial period of four to six weeks at the highest dose that can be tolerated before determining its efficacy.

How Is Buspar Different Than Benzodiazepines?

How Buspar works is dissimilar to how benzodiazepines work.

Benzodiazepines work by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits the activity of neurons in the brain. This leads to a rapid reduction in anxiety symptoms, but it can also lead to side effects such as sedation, dizziness, and cognitive impairment. Benzodiazepines also have a high potential for dependence and withdrawal, which limits their long-term use.

Overall, benzodiazepines are typically used for the short-term treatment of anxiety symptoms or for acute episodes of anxiety, while Buspar is used for the long-term management of anxiety disorders.

I think that it is important to note that several studies, including a Cochrane Review, have reported that Buspar appears to be less effective in individuals who have previously been taking a benzodiazepine. Below is an excerpt from this review:

Azapirones [such as buspirone] appeared to be useful in the treatment of GAD [generalized anxiety disorder], particularly for those participants who had not been on a benzodiazepine. Azapirones may not be superior to benzodiazepines and do not appear as acceptable as benzodiazepines.

Cochrane Database Syst Rev. 2006 Jul; 2006(3)

Does Buspar Cause Withdrawal Symptoms?

Unlike benzodiazepines, Buspar does not appear to cause withdrawal symptoms or dependence.

The prescribing information for the drug notes that in both human and animal studies, Buspar has been shown to have no potential for abuse or diversion, and there is no evidence to suggest that it leads to physical or psychological dependence.

However, it is important to note that some small studies have noted that the discontinuation of any Buspar can cause withdrawal symptoms, including anxiety, insomnia, and irritability.

It isn't known in these studies if these symptoms were directly linked to Buspar discontinuation, but it nevertheless is prudent for individuals to always work closely with their healthcare provider when starting or stopping any medication, to ensure proper monitoring and management of potential adverse effects.

Herbal Options?

There are plenty of herbals that are purported to have anti-anxiety effects, but overall, the evidence for their effectiveness is lacking when compared to pharmaceutical options.

Nevertheless, they may certainly have a place in therapy for certain individuals. Below is a list of some common herbals used to treat anxiety, along with a link to a study discussing their effectiveness:

One of the challenges in recommending herbal remedies for anxiety is the lack of standardization and quality control in the production of these products.

The dose and potency of these herbs can vary widely between products, and the efficacy and safety of these remedies cannot be reliably determined without proper testing and regulation.

Additionally, as a general statement, there is limited scientific evidence to support the efficacy of these herbal remedies for treating anxiety, especially when compared to their pharmaceutical counterparts.

Now, I certainly am a proponent of herbal remedies being a potential therapeutic option for some individuals, but everyone's medical situation is different.

It is important to discuss the use of any herbal remedies with a healthcare professional before taking them, particularly if you are taking other medications or have underlying health conditions. 

Final Words

Before I end here, you mentioned a couple of other things in your question that I want to touch on.

I'm not sure why your doctor mentioned to you that Buspar can be an effective treatment for anxiety when used intermittently.

The only thing I can think of is that the drug hasn't been evaluated over the long term in many studies. In fact, the prescribing information for the drug specifically notes that the effectiveness of BuSpar past 3 to 4 weeks hasn't been evaluated. Therefore, Buspar is sometimes referred to as a 'short-term' option for anxiety. Perhaps something got confused here.

Nevertheless, there have been more studies on Buspar published since the prescribing information for the drug was released, and there certainly is more evidence showing the drug can be a safe and effective long-term solution for anxiety.

Lastly, I'm not sure exactly what you mean regarding a 'cleaner' version of Buspar.

I imagine you are talking about the inactive ingredients contained in pharmaceutical products. I do know for a fact that compounding pharmacies can make compounded prescriptions of buspirone, generally with fewer excipients (i.e., inactive ingredients), but there is a chance that your insurance won't cover a compounded drug if it is commercially available.

I hope this answer helped!

Reach back out anytime.

References

  • Buspar Prescribing Information, AccessFDA
  • A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults, PubMed
  • Ginkgo biloba special extract EGb 761 in generalized anxiety disorder and adjustment disorder with anxious mood: a randomized, double-blind, placebo-controlled trial, PubMed
  • Kava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo-controlled 25-week outpatient trial, PubMed
  • Azapirones for generalized anxiety disorder, PubMed
  • Valerian for anxiety disorders, PubMed
  • Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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