the patients for treatment according to the present invention are minimally characterized by the first two manifestations listed below which are exhibited to a modrate or high degree of severity and preferably at least three of the others listed as ( 3 ) through ( 17 ). ( 3 ) fears of fainting , screaming , losing control , crowds , places , disaster , death ( 10 ) trouble catching breath , air hunger , smothering , lump in throat , choking the patients are preferably rated before commencing treatment according to one or more of the established psychometric rating scales for neurotic patients . the same psychometric methods may then be used to evaluate the patient periodically during the treatment period , preferably every 2 or 3 days until the appropriate dosage schedule has been determined and then at weekly intervals . various suitable rating scales have been described in the literature . they have been collected in a form readily adapted to clinical use by the u . s . department of health , education and welfare in a volume by william guy entitled &# 34 ; ecdeu assessment mannual for psychopharmacology ,&# 34 ; revised 1976 , national institute of mental health , 5600 fishers lane , rockville , maryland 20852 ( dhew publication no . ( adm ) 76 - 338 ). ecdeu is an acronym for early clinical drug evaluation unit . some of these psychometric rating scales which are suitable for this invention are listed below . the page numbers refer to the foregoing collection . other rating scales as may suit the psysician or psychiatrist may also be employed . also , other tests as may be deemed desirable by the physician or psychiatrist in accord with good medical practice should be employed such as a complete medical history and physical examination . dosage is commenced at from 10 mg . to 20 mg . per day , and then increased step - wise until an anxiolytically effective dose is achieved without toxic effect . the dose may then be reduced to establish the optimal effect - minimal dose relationship . this usually occurs in the range of 20 - 30 mg . per day , but doses as high as 60 mg . per day may be employed . doses as high as about 100 mg . are without substantial adverse effects in normal or neurotic individuals . dosage on a b . i . d . or t . i . d . schedule is preferred . open study .-- thirty patients diagnosed as suffering from anxiety reaction were entered into an evaluation of buspirone hydrochloride for treatment of the condition . seven of the thirty patients also exhibited significant symptoms of depression in addition to their predominating symptoms of anxiety reaction . the duration of the study was four weeks . seven patients dropped out of the study and were not included in the analysis of the results . two of these suffered side effects by the second day of treatment , one was improved by the seventh day of treatment , and the other four were lost to follow - up for unknown reasons . all patients entered into the study had a rating on the hamilton anxiety scale ( op . cit .) of at least 18 on entry into the study . anxiety symptoms had been present for at least a month in all cases , and 19 had suffered the symptoms for a year or more . none of the patients exhibited evidence of schizophrenia , affective psychosis , convulsive disorders , organic brain syndrome , strong sociopathy , drug addiction , or alcoholism . the patients were rated on entry into and at the conclusion of the study and weekly according to the hamilton anxiety scale ( ham - a op . cit . ), the hamilton depression scale ( ham - d op . cit . ), and by a physician &# 39 ; s questionaire ( pq ) according to which severity of the disease was rated on the following scale : 1 -- not ill ; 2 -- very mild ; 3 -- mild ; 4 -- moderate ; 5 moderately severe ; 6 -- severe ; 7 -- extremely severe . other rating methods were also used . the following table shows the average daily dose , and the rating scale results . the ham - a and ham - d ratings at the end of the study were within the normal range , and the pq rating indicated only very mild remaining anxiety . ______________________________________average anxiety ratings and dosagesdailydose ( mg .) ham - a ham - d pq n . sup . 3______________________________________outset 0 21 . 5 12 . 1 4 . 5 23week 1 21 . 3 11 . 0 . sup . 1 8 . 8 . sup . 2 3 . 6 . sup . 2 23week 2 25 . 1 8 . 3 . sup . 1 7 . 4 . sup . 2 2 . 9 . sup . 2 16week 3 24 . 1 5 . 5 . sup . 1 4 . 8 . sup . 1 2 . 5 . sup . 2 13week 4 19 . 9 2 . 8 . sup . 1 3 . 7 . sup . 1 2 . 3 . sup . 2 12______________________________________ . sup . 1 paired ttest relative to outset values significant @ 0 . 01 level . . sup . 2 paired ttest relative to outset values significant @ 0 . 05 level . . sup . 3 number of patients included in evaluation . double blind study .-- sixty adult out - patients with manifest anxiety were selected for a double - blind parallel study . twenty patients were entered into each of three groups . one group was treated with buspirone hydrochloride , 5 mg . capsule , another with diazepam , 5 mg . tablet contained within a matching capsule , and the third with placebo , inert ingredients in a matching capsule . the starting dose was one capsule b . i . d . ( buspirone hydrochloride 10 mg . or diazepam 10 mg .) and the dose was increased by one or two capsules every two or three days depending upon therapeutic response and side effects . the maximum dose allowable was 60 mg . per day of buspirone hydrochloride or diazepam . laboratory and physical examinations were conducted on admission and at termination of the study and a number of standard psychometric rating scales were administered on admission , at weekly intervals , and at termination of the study . the study duration was four weeks . the results based upon the degree of improvement in the physician &# 39 ; s evaluation and in the patient &# 39 ; s own evaluation are given in the following table . the status of the patients at the end of the study is given , as well as the cumulative results which include drop - outs evaluated at an interim period . __________________________________________________________________________physician and patient evaluation of therapeutic effect therapeutic effect at termination ( no . averages ) no . patients physician evaluation patient evaluation dailytreatment at : in study dropout marked moderate minimal much moderately a little dose ( mg .) __________________________________________________________________________end of study buspirone 14 6 . sup . 1 8 4 2 10 1 3 23 . 7 . sup . 5 diazepam 14 6 . sup . 2 7 4 3 9 2 3 26 . 4 . sup . 5 placebo 10 10 . sup . 3 1 2 7 3 -- 7cumulativeresults : buspirone 18 2 . sup . 4 10 4 3 12 3 3 19 . 6 diazepam 20 none 7 6 7 10 3 7 18 . 7 placebo 18 2 . sup . 4 1 2 15 3 -- 15__________________________________________________________________________ . sup . 1 one dropped out because of side effects ; one due to unrelated illness ; two because of improvement ; two for unknown reasons . . sup . 2 three dropped out because of side effects ; one due to unrelated changed life situation ; two because of improvement . . sup . 3 two dropped out during the first week for unknown reasons ; the remainder dropped out subsequently due to lack of improvement . . sup . 4 dropouts where no interim evaluation was obtained . . sup . 5 during fourth week . the therapeutic effect with buspirone hydrochloride was comparable to that obtained with diazepam . buspirone had fewer side effects than either diazepam or placebo . only three patients complained of side effects under buspirone . these occurred within the first two weeks and only one patient dropped out because of side effects ( moderate dizziness , cold sweat ). ten patients complained of side effects under diazepam but only three dropped out for this reason ( weakness , tiredness , nausea , vomiting , insomnia , vivid dreams , drowziness , depression , dry mouth , dizziness , excitement , confusion , tachycardia , tremor , blurred vision , and headache ). six patients complained of side effects under placebo but none dropped out for this reason . placebo drop - outs were due to lack of therapeutic effect . in addition , buspirone appeared to be effective in relieving depression in patients presenting with mixed anxiety and depression symptoms . sleep information gathered during the study indicated that the patients slept more deeply under diazepam in contrast to the lighter sleep reported by the buspirone patients . a deeper sleep would accord with the sedation action of diazepam . ______________________________________ 5 mg . 10 mg . tablet tablet______________________________________buspirone hydrochloride 5 . 0 mg 10 . 0 mglactose , anhydrous direct compression 55 . 7 111 . 4starch , sodium carboxy - methyl 8 . 0 16 . 0cellulose , microcrystalline , nf 30 . 0 60 . 0colloidal silicon dioxide 0 . 5 1 . 0magnesium stearate 0 . 8 1 . 6 total 100 . 0 200 . 0______________________________________ 2 . 0 pass the blended material from step 1 through a screen .
buspirone hydrochloride is an effective anti - anxiety agent for the palliative treatment of neurotic patients in which symptoms of anxiety are predominant at doses which are without observable effect in either normal individuals or psychotic patients .