Posted by Chairman_MAO on March 2, 2006, at 21:23:37
In reply to Re: Yes » Chairman_MAO, posted by zeugma on March 2, 2006, at 20:30:29
It makes no sense to me to say that it treats mild anxiety after six weeks. Mild anxiety often comes and goes on its own in about that long. More than one psychiatrist I've talked to has told me that buspirone is "the most expensive placebo on the market". My psychopharmacology professor at Syracuse University told me that it was a failed attempt at developing an antipsychotic that was sold for anxiety in order to recover development costs. If you do enough studies on something, by change you will get a difference from placebo. They only have to show the studies that succeed to the FDA, and voila--your treatment for anxiety. What do you use for anxiety? If anything, I'll bet its not buspirone...
Anxiolytic drugs are those which relieve anxiety upon administration. Benzodiazepines, barbiturates, many antipsychotics, opioids, phenelzine's GABA-T inhibitng metabolite, kavalactones, mirtazapine...even hydroxyzine, diphenhydramine, and trazodone are more anxiolytic than buspirone. Valproate is more of an anxiolytic than buspirone. SSRIs are not anxiolytics, either. They attenuate felt emotion and lessen the number of thoughts coming into consciousness (in most people). Calling them anxiolytics is like calling an anesthetic an analgesic. Sure, if you can't feel ANYTHING, you won't be in pain. The reason many people feel more anxious when starting an SSRI is because they INDUCE ANXIETY. Then, after you adjust to that 4-6 weeks later, you no longer feel the SSRI-induced anxiety, but the emotional anesthetic effect is still maintained. Thus, it seems like something "kicked in". It takes a lot longer to realize what really happened, but I'll bet a lot of people who have taken these medications will agree with me. One may argue that benzos et. al. do this in a way that feels differently. Well, at least that way FEELS CALMER and is directly correlated with the administration of the drug.
Sure, it has an action: a 5ht1a partial agonist, too-weak-to-matter dopamine blockade, and mCPP's actions. "Placebo" does not mean "devoid of any effects". It does have those effects; if you take too much buspar, they become strong enough to notice (I drank grapefruit juice once by accident with it and had quite a bad time). It feels horrible. It is simply not an anxiolytic drug. Buspirone can help with certain SSRI side effects quite well in some cases and can speed an antidepressant response. And yes, in animal models 5ht1a agonists screen as anxiolytic. However, no one ever asked the rats how they were feeling.
A benzodiazepine will calm someone in psychosis, as will Seroquel, et. al. 2g of buspirone will do nothing (maybe induce dizziness and vomiting).
Is there anyone here who had crippling anxiety that was unmanageable, sought pharmacological treatment, and then found relief from buspirone?
The placebo effect is so powerful that it is present even when investigating treatments for very serious disorders that often involve extreme pain, discomfort, etc. That being the case, does it make sense to deem buspirone anxiolytic given that it has virtually no subjective effect at clinical dosages?