Buspirone - anyone?

persevere · April 16

Briefly my DW is in stage 7, under hospice, on several meds including serequol, depakote, lexapro, and Valium as needed. Also temazepam for sleep. Total aphasia. Days are usually 80% walking, bumping, mumbling (all the time) and 20% laying down or sitting. The issue is she’s usually walking with eyes almost closed. Can’t get her down. The drugs make her sedated (walking zombie) but without them she’s in hyper drive. So hospice is recommending cutting back on serequol and introducing buspiron (or busbar I think is the slang). Anyone have any experience here? I did a search here but really didn’t find much. I really have my doubts.

Jeff H · April 16

Hospice care is great, but I would consult a neurologist for recommendations. I realize stage 7 is pretty late so I don't know if a neurologist would intervene.

I looked it up using AI. I hope you don't mind..

Here is a brief overview of busprion via AI:
Buspirone works by affecting brain chemicals like serotonin and dopamine, helping reduce anxiety without the sedating effects you might see with drugs like benzodiazepines.

Key points

Not fast-acting: It usually takes 2–4 weeks to feel full effects
Non-addictive: Unlike drugs such as Xanax or Ativan
Doesn’t cause much sedation: Most people stay alert
Taken regularly: Not “as needed” for panic attacks

Buspirone can be used in people with late-stage Alzheimer's disease, but it’s not usually a first-choice medication—and its usefulness depends on what symptoms you’re trying to treat.

Where it can help

Buspirone is sometimes used for:

Generalized anxiety
Mild agitation or restlessness

In dementia patients, one advantage is that it:

Doesn’t sedate heavily
Has low risk of dependence
Causes less confusion than some stronger drugs

Limitations in late-stage Alzheimer’s

It works slowly (weeks), which is a problem if symptoms are severe or urgent
It’s often not strong enough for significant agitation, aggression, or psychosis
Evidence in advanced dementia is mixed and somewhat limited

What’s more commonly used instead

For more serious behavioral symptoms in late-stage Alzheimer’s, doctors often consider:

SSRIs (for anxiety, irritability)
Antipsychotics like Risperdal or Zyprexa (used cautiously due to risks)
Sometimes meds like Seroquel

persevere · April 16

Thanks Jeff. I appreciate the legwork. I too discussed with chtgpt. I think my wife has been a tough nut to crack. Even the very experienced hospice nurse seems a little mystified by the situation. Some of the antipsychotics can have paradoxical effects and so that could be the case with the serequol. I dunno. It’s really a roller coaster from day to day. As for a neurologist, at this point I couldn’t get her to sit in the car long enough to make the trip much less do an office visit. I feel like these hospice drs see enough of this that they should be as skilled as the neurologists but you never know.

tboard · April 16

https://alzconnected.org/discussion/75821/buspirone-anyone

I wasn't able to give my DH Buspirone when he lived at home because when I did he would sleep around the clock. Maybe his dosage was too high?

harshedbuzz · April 16

@persevere

I am sorry your wife is experiencing these symptoms. The constant motion version of late-stage dementia a challenge for all involved.

Is there anyway hospice would allow a consult with a geri psych under comfort care? Your wife is already on what appears to be a thoughtfully chosen cocktail of medications that are associated with calming but that can cause sleepiness and increase her fall risk. That said, they don't seem to be working well. That may be due to her disease progression, but it makes sense to try to improve her quality of life.

Have you spoken with the hospice physician assigned to ask about this? Assuming she's tolerating the Seroquel, might it make more sense to increase that dose or try another atypical antipsychotic instead? One concern I would have is that some folks have insomnia and/or a kind of edginess as a side effect which could be a problem. There's also the slight (~2 week) lag-time in effectiveness.

HB

persevere · April 16

https://alzconnected.org/discussion/comment/270457#Comment_270457

HB, good feedback. Thanks. We live in a smallish area and just a quick search doesn’t show any geri psychs nearby although tele com is sometimes used. I can ask hospice. But I’ve got a good nurse now (didn’t before) and the PA has visited a few times so I think they are finally getting a good site picture. She’s up to 100mg of serequol 3 times a day but most days I just administer 2. Just too much sedation with her on her feet. When you mentioned edginess and insomnia side effects were you talking about serequol or buspirone?

marier · April 16

My DH was on seroquel which made him extremely agitated and Buspirone which I felt didn't help. He was also on some other anti-physc. meds in low doses. These drugs caused agitation as well. We slowly took him off all anti-physc as well as the Buspirone. He is doing very well on 25mg of sertraline once day and trazodone 50 mg at night. Both of these meds can be increased if needed. The trazodone was also used if needed at 12.5 to 25 mg during the day for agitation. This was only needed a couple of times. We started these changes when he was stage 6 and he now is stage 7 and slowly progressing.

harshedbuzz · April 16

@persevere

Buspirone (brand name Buspar) has restlessness/edginess as a reported side effect. That doesn't mean your DW will absolutely have that, but it's worth keeping an eye out. Buspirone has a reputation for being less sedating than similar meds.

This is a tough one. It's hard to dial back the constant motion, especially in the context of things like weight loss and fall-risk. I've seen the semi-shut while awake in 2 other PWD I know in the later stages. It almost seemed to me like their visual processing was so poor that what they saw confused them so they shut it out.

FWIW, and this is just anecdotal, I found Lexapro exhausting to take. It was great initially for a recurrence of PTSD, but over time as I was doing better it made me so tired that I was sleeping 12+ hours a day and still sleepy.

HB

H1235 · April 16

I take buspirone to help with my anxiety from caring for my mom with dementia and a very difficult sibling. I was told by my doctor it is very very mild and I’m probably on a low dose as well. Seroquel is an antipsychotic. I think this is an intense (don’t know the right word) medication. They seem like very different extremes to me. I would be surprised if buspirone could provide her the same mental comfort. It’s my understanding that seroquel would need to be tapered down. If the buspirone is not effective and she went back to seroquel it would need to be taped up to her previous dose. When the doctor changed moms antidepressant it was almost 6 months before it was sorted out and mom was an emotional wreck during the process.

Jeff H · 2:00AM

https://alzconnected.org/discussion/comment/270450#Comment_270450

I agree. I'm sorry for your situation. Yes, hospice is best at this stage. 🙏

Buspirone - anyone?

Comments

Key points

Where it can help

Limitations in late-stage Alzheimer’s

What’s more commonly used instead

Commonly Used Abbreviations

Community Guidelines

Categories