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
• 2. Application of Buspirone
• 3. Contraindications / cross effects

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)