What is the role of Hydroxyzine (an antihistamine) for anxiety?

From the Guidelines

Hydroxyzine is a viable option for treating anxiety, particularly in cases where other medications may be contraindicated or less effective, as seen in the study published in the European Journal of Nuclear Medicine and Molecular Imaging 1. The medication is available as Vistaril or Atarax and is typically prescribed at doses of 25-50mg taken 3-4 times daily as needed for anxiety symptoms. It belongs to the antihistamine class and works by affecting histamine and serotonin in the brain, which helps reduce anxiety. Unlike benzodiazepines, hydroxyzine is non-habit forming and doesn't cause physical dependence, making it suitable for both short and long-term anxiety management. Some key points to consider when prescribing hydroxyzine for anxiety include:

• Common side effects include drowsiness, dry mouth, and mild dizziness, which typically improve with continued use.
• The sedative properties can be beneficial for those with anxiety-related sleep difficulties.
• Hydroxyzine should be used cautiously with other medications that cause drowsiness.
• It is essential to discuss the use of hydroxyzine with a doctor if you're pregnant, breastfeeding, or have narrow-angle glaucoma or certain heart conditions. However, it's crucial to weigh the benefits and risks, considering the potential for sedation, performance impairment, and anticholinergic effects, as highlighted in the study published in the Journal of Allergy and Clinical Immunology 1. Additionally, the study published in the Journal of the American Academy of Child and Adolescent Psychiatry 1 emphasizes the importance of considering alternative treatments, such as cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication, which have considerable empirical support as safe and effective short-term treatments for anxiety in children and adolescents. Ultimately, the decision to use hydroxyzine for anxiety should be made on a case-by-case basis, taking into account the individual patient's needs and medical history, as well as the potential benefits and risks associated with the medication, as discussed in the study published in the Annals of Internal Medicine 1.

From the FDA Drug Label

For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested. Hydroxyzine is used for symptomatic relief of anxiety and tension.

• The drug is indicated for anxiety associated with psychoneurosis.
• It can be used as an adjunct in organic disease states where anxiety is present. The effectiveness of hydroxyzine for long-term use (more than 4 months) as an antianxiety agent has not been assessed by systematic clinical studies 2.

From the Research

Hydroxyzine for Anxiety

• Hydroxyzine is an anti-histamine medication that has been used in the treatment of anxiety, as studied in 3 and 4.
• The efficacy of hydroxyzine in comparison with placebo or any other active agent in alleviating the acute symptoms of generalized anxiety disorder (GAD) has been investigated, with results showing that hydroxyzine is more effective than placebo for GAD 3.
• A 3-month double-blind study found that hydroxyzine showed both efficacy and safety in the treatment of GAD, with results confirming the efficacy of hydroxyzine over placebo 4.
• Compared to other anxiolytic agents, such as benzodiazepines and buspirone, hydroxyzine was equivalent in terms of efficacy, acceptability, and tolerability 3.

Comparison with Other Treatments

• A meta-analytic review compared the efficacy of benzodiazepines and serotonergic anti-depressants for adults with GAD, finding that benzodiazepines were the most effective drug, while selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) demonstrated lower effect sizes 5.
• A 3-level network meta-analysis found that all SSRIs and SNRIs were effective for multiple symptom domains, with minimal differences between medications concerning efficacy and acceptability 6.
• Combining SSRIs with cognitive behavioral therapy (CBT) has been shown to produce greater improvement than either treatment alone in youth with depression and anxiety 7.

Safety and Tolerability

• Hydroxyzine was associated with a higher rate of sleepiness/drowsiness than active comparators, but safety results were comparable in the 3 groups 4.
• The study found no statistically significant difference between hydroxyzine and bromazepam in terms of safety, except for drowsiness, which was more frequent with bromazepam 4.