A 30-year-old woman comes to the office due to chronic anxiety and tension. The patient says she worries constantly about multiple issues involving her work, finances, and family. At work, she has difficulty concentrating as she repeatedly calls to check on the whereabouts and safety of her husband and children. The patient also describes frequent tension headaches, back pain, and fatigue. She does not feel depressed and says that her sleep and appetite are normal. Laboratory studies, including thyroid function tests, are within normal limits. In addition to a recommendation of psychotherapy, pharmacotherapy with buspirone is initiated. This medication is associated with which of the following properties?
This patient's chronic anxiety about multiple issues and associated symptoms of muscle tension, impaired concentration, and fatigue are consistent with a diagnosis of generalized anxiety disorder (GAD). Buspirone is a nonbenzodiazepine anxiolytic used in the treatment of GAD that has no risk of dependence in contrast to the substantial risk associated with benzodiazepines.
(Choices A, B, and D) Buspirone acts as a partial agonist of the 5HT1A receptor. In contrast to benzodiazepines, which act at GABA-A receptors, buspirone primarily affects serotonin and has no muscle relaxant or anticonvulsant properties. Buspirone is also not effective in treating panic disorder.
(Choice C) Buspirone has fewer sedative and hypnotic effects compared to benzodiazepines and does not cause euphoria.
(Choice F) Buspirone is not useful in the acute setting because it requires up to 2 weeks for the anxiolytic effect to begin.
Educational objective:
Buspirone is a nonbenzodiazepine anxiolytic used to treat generalized anxiety disorder. It has a slow onset of action, lacks muscle relaxant or anticonvulsant properties, and carries no risk of dependence.