Buspirone
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Buspirone is a non-addictive medication primarily used to treat anxiety disorders.  It is generally a more mild medication with fewer side-effects but also less effective.  It is available as a generic for around $25 per month for 10 mg. three times a day.  Hydroxyzine, an even lower cost generic which also has few side-effects, did better than buspirone in the one head-to-head comparison study.

While many earlier, industry-funded studies found buspirone as effective as benzodiazepines for anxiety with fewer side-effects and no addictiveness, the clinical experience of many psychiatrists did not confirm this effectiveness. More recent studies have also documented a lower level of effectiveness compared to hydroxyzine, anti-depressants, or benzodiazepines.

Alcoholism: Buspirone, Lithium No Help: In a DB PC 6-month study of 156 alcoholics, there was no significant difference in staying in the program, abstinence, or amount of alcohol consumed. Pharmacological treatments for alcoholism: revisiting lithium and considering buspirone. Fawcett J, Kravitz HM, McGuire M, Easton M, Ross J, Pisani V, Fogg LF, Clark D, Whitney M, Kravitz G, Javaid J, Teas G.  Rush-Presbyterian. Alcohol Clin Exp Res. 2000 May;24(5):666-74; Similar lack of benefit for buspirone in a DB PC study of 67 alcoholics. Alcohol Clin Exp Res. 1992 Dec;16(6):1007-13

Buspirone BID = TID: In a DB study of 289 Generalized Anxiety Disorder patients treated with buspirone 10mg t.i.d. or 15 mg b.i.d., no differences were found except 5% palpitations with the b.i.d. vs. 1% with the t.i.d. Meta-analysis of the safety and tolerability of two dose regimens of buspirone in patients with persistent anxiety. Sramek JJ, Hong WW, Hamid S, Nape B, Cutler NR. Depress Anxiety 1999;9(3):131-4

Drug Addicts: Buspirone Tended to Help: In a twelve-week, DB PC trial of buspirone in 36 opioid-dependent patients receiving methadone-maintenance who presented with anxiety symptoms, buspirone did not significantly reduce anxiety symptoms. However, it was associated with trends toward reduction in depression scale scores and a slower return to substance use. MUSC. A randomized, placebo-controlled trial of buspirone for the treatment of anxiety in opioid-dependent individuals. McRae AL, Sonne SC, Brady KT, Durkalski V, Palesch Y. Am J Addict. 2004 Jan-Feb;13(1):53-63

Erythromycin or Itraconazole Greatly Increased Buspirone: Due to blockage of CPY3A4, buspirone increased 6- and 19-fold in 8 healthy volunteers. Plasma buspirone concentrations are greatly increased by erythromycin and itraconazole. Kivisto KT, Lamberg TS, Kantola T, Neuvonen PJ. Clin Pharmacol Ther 1997 Sep;62(3):348-54

Fluoxetine Benefit in Depression Slowed by Buspirone: In a open label random assignment study of fluoxetine 20, fluoxetine 40, or fluoxetine 20mg/day plus buspirone 20 mg/day, a 50% decrease in the HAM-D depression rating was achieved in 33, 24, and 40 days respectively. Turkey. Faster response in depressive patients treated with fluoxetine alone than in combination with buspirone. Onder E, Tural U. J Affect Disord. 2003 Sep;76(1-3):223-7

Generalized Anxiety Disorder: Buspirone Very Slightly Better Than Placebo: 112 pt DB PC buspirone 15-45/d. Efficacy of buspirone in generalized anxiety disorder with coexisting mild depressive symptoms. 48% vs. 38% decrease HAM-A and lesser difference in decrease on HAM-D. Sramek JJ, Tansman M, Suri A, Hornig-Rohan M, Amsterdam JD, Stahl SM, Weisler RH, Cutler NR. J Clin Psychiatry 1996 Jul;57(7):287-91

Generalized Anxiety: Hydroxyzine Did Better than Buspirone which was Better than Placebo: In a DB PC study of buspirone 5 b.i.d.and 10 hs. vs. hydroxyzine 12.5 b.i.d. and 25 hs. vs. placebo of 244 patients for 4 weeks, dropout were equal in all three groups and small. Hydroxyzine did significantly better than placebo on HAM-A. Both buspirone and hydroxyzine were better than placebo on CGI and self-rating. A multicentre double-blind comparison of hydroxyzine, buspirone and placebo in patients with generalized anxiety disorder. Lader M, Scotto JC. Psychopharmacology (Berl) 1998 Oct;139(4):402-6

Imipramine Better than Buspirone Helping Benzodiazepine Withdrawal in DB: 107 pt on diazepam, alprazolam or lorazepam for average 8.5 yr. kept on stable dose while started on 4 weeks imipramine (aver. 180/d), buspirone (aver 38/d) or placebo then had benzodiazepine gradually withdrawn over 4 weeks then placebo withdrawal of meds for 3 weeks. Average had 3 previous unsuccessful tapers. 83% succeeded with imipramine vs. 68% buspirone vs. 37% placebo.  Imipramine and buspirone in treatment of patients with generalized anxiety disorder who are discontinuing long-term benzodiazepine therapy. Rickels K, DeMartinis N, Garcia-Espana F, Greenblatt DJ, Mandos LA, Rynn M. U Penn: Am J Psychiatry 2000 Dec;157(12):1973-9

Imipramine Better than Buspirone for Panic Disorder: In an 8-week, 50-patient DB PC study, imipramine did significantly better than buspirone which only had a trend in its favor over the placebo.  The relative efficacy of buspirone, imipramine and placebo in panic disorder: a preliminary report. Sheehan DV, Raj AB, Sheehan KH, Soto S. University of South Florida. Pharmacol Biochem Behav. 1988 Apr;29(4):815-7

Lorazepam vs. Buspirone: In a DB PC 125-patient 4-week study with a washout and four week post-treatment follow-up, lorazepam 1 mg t.i.d. did somewhat better during treatment and worse during post-treatment. Buspirone 5 tid. Laakman, U Munich, Psychopharm (Berlin) 98;136:357

Social Phobia: Buspirone No Help: DB PC 12 week buspirone 30mg/d 30 pt. Clinical effects of buspirone in social phobia: a double-blind placebo-controlled study. Utrecht University: van Vliet IM, den Boer JA, Westenberg HG, Pian KL. J Clin Psychiatry 1997 Apr;58(4):164-8

Smoking Cessation: Buspirone No Help: DB PC 100 smokers. Efficacy of buspirone in smoking cessation: a placebo-controlled trial. Schneider NG, Olmstead RE, Steinberg C, Sloan K, Daims RM, Brown HV. Clin Pharmacol Ther 1996 Nov;60(5):568-75

Smoking Cessation: Buspirone No Help: In a DB PC study of 55 heavy smokers (33 cigarettes per day), buspirone 10mg t.i.d. for three weeks before withdrawal and during the two weeks of withdrawal had no significant effect on withdrawal symptoms or abstinence rates. Buspirone effect on tobacco withdrawal symptoms: a randomized placebo-controlled trial. Robinson MD, Pettice YL, Smith WA, Cederstrom EA, Sutherland DE, Davis H. : J Am Board Fam Pract. 1992 Jan-Feb;5(1):1-9

Venlafaxine Better than Buspirone for Generalized Anxiety: In a DB PC 8-week study of 365 patients comparing venlafaxine XR 75-150 mg/day vs. buspirone 10 mg. t.i.d., venlafaxine did better although buspirone was better than placebo. Efficacy, safety, and tolerability of venlafaxine extended release and buspirone in outpatients with generalized anxiety disorder. Davidson JR, DuPont RL, Hedges D, Haskins JT. Duke University. J Clin Psychiatry. 1999 Aug;60(8):528-35