Buspirone for ADHD
Buspirone is an anxiolytic (anxiety-relieving) active ingredient which, unlike benzodiazepines, is said to have no addictive potential. This could be due to the fact that the effect is not immediate, but takes around 14 days or longer. This indicates that the effect is probably achieved via down- or upregulation of receptor systems.
Buspirone does not have a sedative effect.
Product names are Anxut, Busp, Bespar
1. How Buspirone works
The exact effect is unknown. It is suspected:
- No GABA receptor affinity
- Partial agonist at 5-HT1A receptors
- Antagonist at D2 receptors
2. Application of Buspirone
Generalized anxiety disorder (approved).
A randomized double-blind study showed that although buspirone reduced the symptoms of ADHD, its effect was clearly inferior to that of methylphenidate.1 Another randomized double-blind study (which, however, specified fixed drug doses) also found a better reduction in inattention with methylphenidate, with otherwise the same symptom improvements and fewer side effects with buspirone.2
Various other studies also found improvements with buspirone in ADHD3 or ADHD with co-morbid oppositional defiant behavior.4
Atomoxetine and buspirone reduced ADHD symptoms slightly better with an effect size of 0.51 than atomoxetine alone with 0.40.5
Buspirone could possibly help to limit the habituation effects of long-term methylphenidate use.678
Note: The authors mention alleged addictive dangers of methylphenidate. Such a statement was not found in any known scientific study on drug dosing in humans. The statement may therefore at best refer to the effect of the very high doses used in the authors’ experiments on rats, which are significantly higher than the doses used as medication in humans.
Various case studies report a positive effect of buspirone on bruxism caused by atomoxetine or SSRIs.9101112
3. Contraindications / cross effects
Buspirone is degraded via CYP3A4.
Buspirone should not be combined with (among others):
- Serotonin reuptake inhibitors
- Serotonin agonists
- Risk: Serotonin overdose
- MAO-A inhibitors
- Risk: High blood pressure
- Drugs that are metabolized (= broken down) via cytochrome P450 3A4 (CYP3A4)
Mohammadi, Hafezi, Galeiha, Hajiaghaee, Akhondzadeh (2012): Buspirone versus methylphenidate in the treatment of children with attention- deficit/ hyperactivity disorder: randomized double-blind study. Acta Med Iran. 2012;50(11):723-8. ↥
Davari-Ashtiani, Shahrbabaki, Razjouyan, Amini, Mazhabdar (2010): Buspirone versus methylphenidate in the treatment of attention deficit hyperactivity disorder: a double-blind and randomized trial. Child Psychiatry Hum Dev. 2010 Dec;41(6):641-8. doi: 10.1007/s10578-010-0193-2. ↥
Niederhofer (2003): An open trial of buspirone in the treatment of attention-deficit disorder. Hum Psychopharmacol. 2003 Aug;18(6):489-92. ↥
Gross (1995): BUSPIRONE IN ADHD WITH ODD; Journal of the American Academy of Child & Adolescent Psychiatry, Volume 34, Issue 10, 1260 ↥
Sutherland Adler, Chen, Smith, Feltner (2012): An 8-week, randomized controlled trial of atomoxetine, atomoxetine plus buspirone, or placebo in adults with ADHD. J Clin Psychiatry. 2012 Apr;73(4):445-50. doi: 10.4088/JCP.10m06788. ↥
Alam, Najam, Khan (2015): Attenuation of methylphenidate-induced tolerance on cognition by buspirone co-administration. Pak J Pharm Sci. 2015 Sep;28(5):1601-5. ↥
Alam, Najam, Naeem (2016): Attenuation of methylphenidate-induced sensitization by co-administration of buspirone. Pak J Pharm Sci. 2016 Mar;29(2):585-90. ↥
Alam, Ikram (2018): Methylphenidate-induced hepatotoxicity in rats and its reduction by buspirone. Pak J Pharm Sci. 2018 May;31(3):741-745. ↥
Yüce M, Karabekiroğlu K, Say GN, Müjdeci M, Oran M (2013): Buspirone use in the treatment of atomoxetine-induced bruxism. J Child Adolesc Psychopharmacol. 2013 Nov;23(9):634-5. doi: 10.1089/cap.2013.0087. PMID: 24206098; PMCID: PMC3842865. ↥
Bostwick JM, Jaffee MS (1999): Buspirone as an antidote to SSRI-induced bruxism in 4 cases. J Clin Psychiatry. 1999 Dec;60(12):857-60. doi: 10.4088/jcp.v60n1209. PMID: 10665633. ↥
Jaffee MS, Bostwick JM (2000): Buspirone as an antidote to venlafaxine-induced bruxism. Psychosomatics. 2000 Nov-Dec;41(6):535-6. doi: 10.1176/appi.psy.41.6.535. PMID: 11110119. ↥
Wise M (2001): Citalopram-induced bruxism. Br J Psychiatry. 2001 Feb;178:182. doi: 10.1192/bjp.178.2.182. PMID: 11157444. ↥