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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Racer on January 1, 2006, at 15:38:26
I see that new pdoc tomorrow, and am thinking about asking about Buspar for my anxiety -- which is currently through the stratosphere. Now I want to know if anyone has found it helpful -- since I've been told that *most* people who try it have not found it helpful -- and whether it caused weight gain? The source of the 'not worth trying, since very few people find it offers any relief at all' was Dr CattleProd, who generally seemed to know his stuff when it came to drugs. But I gotta do something, and it is Catagory B.
Thank you.
Posted by ClearSkies on January 1, 2006, at 16:10:11
In reply to Buspar stories? Weight gain?, posted by Racer on January 1, 2006, at 15:38:26
I tried it in conjunction with Effexor, and it made me foggy but no less anxious. So many meds did not combine well with Effexor, though. On reflection I doubt whether anything would have worked - my anxiety was enormous and unremitting at the time. Xanax was what eventually brought my internal tremors down to a manageable level. Even Klonopin didn't help with the intensity of anxiety that I felt.
Now things are on a much more even keel. The anxiety is less of a constant state than a daily twinge. I think that Buspar would probably work if I asked my p-doc for another try.Good luck at the p-doc, Racer. You have a whole bunch of friends wishing you well.
CS
Posted by zeugma on January 1, 2006, at 16:21:11
In reply to Buspar stories? Weight gain?, posted by Racer on January 1, 2006, at 15:38:26
more of an antidepressant than an anxiolytic.
it did not cause weight gain. Nothing short of Provigil can cause me to gain weight. So perhaps my biochemsitry is so atypical as to be of no prognostic use whatsoever.
But the theory about this drug is that it is effective, but has a slow onset of action, and has been used (foolishly) in the past as a way to taper off benzodiazepines- imipramine is a better choice for that, and a far more potent AD as well. IMO it is (or was) mismarketed as an anxiolytic- its close chemical relative gepirone has been through trials in the U.S. as an antidepressant and found effective, but thanks to FDA policy has not received approval. Evidence of gepirone's efficacy:
Gepirone ER would be far more effective than buspirone, mainly because of buspirone's unstable pharmacokinetics. There are similar reports when comparing Concerta to immediate-release methylphenidate, etc. But the FDA in its wisdom has put the brakes on gepirone, perhaps because companies such as Lilly and Wyeth could not throw their prestige behind the new drug. Buspirone is worth a shot, though, and perhaps a three-times-daily dosing schedule.
-z
Posted by mogger on January 1, 2006, at 16:46:24
In reply to Re: Buspar stories? Weight gain? » Racer, posted by zeugma on January 1, 2006, at 16:21:11
Buspar has been a life saver as far as ocd and anxiety for me. I take 90mg a day which is well over the average but boy do I need it and it helps trememndously.
mogger
Posted by TrishP on January 1, 2006, at 16:56:39
In reply to Re: Buspar stories? Weight gain?, posted by mogger on January 1, 2006, at 16:46:24
I've tried taking Buspar. It seems to help some, but sometimes it also seems to make me a little more anxious.
The problem for me is that it also makes this crazy monster hunger hit and I almost can't wait to eat. I'm afraid if I stayed on it I would gain more and more weight.
Zoloft - which is also supposed to be good for anxiety, made me more anxious and eat like a maniac too though.
Posted by Phillipa on January 1, 2006, at 18:32:28
In reply to Re: Buspar stories? Weight gain?, posted by TrishP on January 1, 2006, at 16:56:39
Racer I don't know if you've ever taken benzos. But I was told that it wouldn't work if you have. I was given it with benzos and no go. Now they say that high doses work. Would think it would be wt neutral. Fondly, Phillipa
Posted by 4WD on January 1, 2006, at 22:14:33
In reply to Buspar stories? Weight gain?, posted by Racer on January 1, 2006, at 15:38:26
> I see that new pdoc tomorrow, and am thinking about asking about Buspar for my anxiety -- which is currently through the stratosphere. Now I want to know if anyone has found it helpful -- since I've been told that *most* people who try it have not found it helpful -- and whether it caused weight gain? The source of the 'not worth trying, since very few people find it offers any relief at all' was Dr CattleProd, who generally seemed to know his stuff when it came to drugs. But I gotta do something, and it is Catagory B.
>
> Thank you.
Racer,I'll let you know. I start it in a couple of days. I asked my pdoc for it because I'm sick of taking klonopin and hoping the buspar will eventually be enough and I'll be able to stop the Klonopin.
I've been prescribed a very low dose to start with - 10mg twice a day, since I'm generally very med sensitive. Pdoc says it will take at least a week before I can tell any difference. (I bet side effects show up quicker than that though). Anyway, I'll post here about results and hunger/weight gain stuff. I have not had any weight gain with any ssri or snri, though. In fact they all helped my bulimia.
My pdoc says they reason people think buspar isn't effective if you've taken benzos is because people try to switch from a benzo to buspar and then are disappointed because it doesn't work immediately and doesn't give the same feeling.
Marsha
Posted by Phillipa on January 1, 2006, at 22:25:15
In reply to Re: Buspar stories? Weight gain? » Racer, posted by 4WD on January 1, 2006, at 22:14:33
Marsha what does that mean. I mean if it doesn't help at first will you wean down on klonopin first? And how does buspar make you feel? Some people like klonopin and say it relaxes them me it just depressed. Fondly, Phillipa
Posted by jflange on January 1, 2006, at 22:46:56
In reply to Re: Buspar stories? Weight gain? » Racer, posted by 4WD on January 1, 2006, at 22:14:33
I take Buspar with Zoloft and it has really helped me a great deal. No weight gain, no sexual s/e after the first week or so. It's great for anticipatory anxiety and GAD.
Buspar is not good for panic at all. That's what SSRIs are for.
Feel better,
jflange
Posted by 4WD on January 3, 2006, at 21:36:38
In reply to Re: Buspar stories? Weight gain? » 4WD, posted by Phillipa on January 1, 2006, at 22:25:15
> Marsha what does that mean. I mean if it doesn't help at first will you wean down on klonopin first? And how does buspar make you feel? Some people like klonopin and say it relaxes them me it just depressed. Fondly, Phillipa
I meant that if the buspar seems to help with the fear (which I still have even though I take Klonopin) then I will try to reduce the klonopin and just take buspar along with celexa. I already took one 10mg buspar yesterday morning and was very depressed all day. I think it had to just be coincidence though. One single Buspar surely could not make me so tired and depressed.
Anyway, I skipped it today. I'm going to wait until the results of all my medical tests are back first I think. And then try it again. If I get very tired and depressed the next time I try it, I might give it one more try, who knows.Marsha
Posted by Racer on January 3, 2006, at 21:57:07
In reply to Re: Buspar stories? Weight gain? » Phillipa, posted by 4WD on January 3, 2006, at 21:36:38
I just started it last night, so I'm going to be taking dose 3 tonight. So far, it didn't cause any lethargy -- beyond what I've been feeling otherwise -- nor increased depression. In fact, I managed to speak with a friend for a longish time today, which surprised me. I haven't felt communicative, and often when it's this bad, I will either not answer, or answer and chase whomever it is off the line.
I hope that helps give you some confidence to try it again, give it a fair shot.
Good luck.
Posted by spiritgirlhere on January 6, 2006, at 11:57:20
In reply to Buspar stories? Weight gain?, posted by Racer on January 1, 2006, at 15:38:26
I just started Buspar two days ago. I am taking 10 mg twice per day. The side effects showed up immediately for me. I have had dizziness and diarrhea; also, feeling more anxious at times. I am also taking Tranxene 3.75 mg twice per day, and have been for about 3 weeks. The goal is to continue the Tranxene for about three more weeks, then take only the Buspar for a few months. I was on Lexapro for one year and came off of it in July. By November, I started having unrelenting anxiety. I've had panic attacks in the past and could control those, but the daily anxiety was too much. I hope this Buspar works b/c I tried to get back on the Lexapro again for four days, and I got really sick from it. I lost 6 lbs. during that time and was constantly freaked out. I'm working with a dual MD/ND, so also started herbs to support my adrenals and had food testing done. Unfortunately, I feel too ill right now to get to the gym for a workout.
Posted by cache-monkey on January 7, 2006, at 13:22:35
In reply to Buspar stories? Weight gain?, posted by Racer on January 1, 2006, at 15:38:26
I tried BuSpar up to 10 mg/day. It decreased my appetite, if anything. But I think it did so because it made my physical anxiety worse. (At the same time I think it helped the psychic component of my anxiety.)
I think the worsening of my physical anxiety had something to do with me being a poor CYP-2D6 metabolizer: the main metabolite of BuSpar, 1-PP, antagonizes the alpha-2 adrenergic receptor leading to more norepinephrine and is cleared by CYP-2D6. If you're a normal for CYP-2D6 metabolism this might not be an issue for you...
Best,
cache-monkey
Posted by yxibow on January 7, 2006, at 13:22:41
In reply to Buspar stories? Weight gain?, posted by Racer on January 1, 2006, at 15:38:26
I didn't really find it particularly anxiolytic and it was dizzy making - ataxia I guess you could call it. Maybe I didnt give it enough time though at least a few weeks I think -- it was a long time ago. I don't think it was responsible for any weight gain.
If you can stand that on a huge dose I suppose its worth trying. Its also worth to note that as you increase the dose "through the stratosphere" you may start feeling effects of an antipsychotic, because thats exactly what it is. A weak, atypical antipsychotic that failed to meet standards for that class and so BuSpar it became for anxiety.
Hope you feel better.
Posted by zeugma on January 8, 2006, at 10:24:52
In reply to Re: Buspar stories? Weight gain? » Racer, posted by yxibow on January 7, 2006, at 13:22:41
A weak, atypical antipsychotic that failed to meet standards for that class and so BuSpar it became for anxiety.>>
it's worth noting that at the time of BuSpar's development, the atypical class consisted solely of clozapine, and the term 'atypical' had not been invented.
Buspirone has been referred to as an atypical antidepressant in the literature with some frequency, which of course means nothing.
Also, BuSpar has been used for the treatment of ataxia.
The point you make about buspirone being implicated in AP-like side effects at very high dosesis borne out, however, by this case study (dosages above 30 mg/day btw are considered "high," and the man, after discontinuing the offending antiretroviral, was able to tolerate 45 mg/day buspirone without ill effects) :
<<1: Ann Pharmacother. 2003 Feb;37(2):202-5.
Pseudo-Parkinson disease secondary to ritonavir-buspirone interaction.Clay PG, Adams MM.
Department of Pharmacy Practice, University of Missouri-Kansas City, Kansas City, MO 64108-2792, USA. claypg@umkc.edu
OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug-drug interaction. CONCLUSIONS: This case demonstrates a severe drug-drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.>>
-z
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