From the Guidelines
Hydroxyzine is a viable option for treating anxiety, but its use should be carefully considered based on individual patient needs and preferences, as well as the potential risks and benefits, as suggested by the most recent guidelines 1. When considering hydroxyzine for anxiety, it's essential to weigh the benefits against the potential side effects, such as drowsiness, dry mouth, and dizziness. The medication works by blocking histamine receptors in the brain, which can help reduce anxiety symptoms quickly, usually within 30 minutes.
- Unlike benzodiazepines, hydroxyzine is non-addictive and can be safely used for longer periods, making it a preferable option for some patients.
- However, it's crucial to note that hydroxyzine should not be combined with other sedating medications or alcohol, and it's not recommended during pregnancy.
- For chronic anxiety, hydroxyzine works best as part of a comprehensive treatment plan that may include therapy and lifestyle modifications, as emphasized in recent clinical practice guidelines 2, 3, 4.
- The choice of anxiolytic, including hydroxyzine, should be informed by the adverse effect profiles of the medications, tolerability of treatment, and patient preference, as highlighted in the guidelines 1.
- A stepped care model, considering variables such as current symptomatology level, functional impairment, and patient preference, can help tailor intervention recommendations and optimize treatment outcomes 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 5.
From the Research
Efficacy of Hydroxyzine for Anxiety
- Hydroxyzine is an anti-histamine medication that has been used in the treatment of anxiety, and studies have shown that it is more effective than placebo for generalized anxiety disorder (GAD) 6.
- Compared to other anxiolytic agents, such as benzodiazepines and buspirone, hydroxyzine was equivalent in terms of efficacy, acceptability, and tolerability 6.
- However, hydroxyzine was associated with a higher rate of sleepiness/drowsiness than the active comparators 6.
Treatment Strategies for Anxiety Disorders
- The first-line treatments for obsessive-compulsive disorder (OCD) include medium-high doses of selective serotonin reuptake inhibitors (SSRIs) and clomipramine, a tricyclic (TCA) antidepressant with prevalent serotonergic activity 7.
- For panic disorder (PD), the recommended drugs include SSRIs, TCAs, and serotonin-norepinephrine reuptake inhibitors (SNRIs), while benzodiazepines like alprazolam may be used in treatment-resistant cases 7.
- Hydroxyzine can be considered a third-line agent for PD, and it may be better to co-administer with antidepressants, particularly with SSRIs, due to its anxiolytic effects without decreasing serotoninergic transmission 8.
Pharmacotherapy for Generalized Anxiety Disorder
- Randomized controlled trials support the efficacy of SSRIs, SNRIs, benzodiazepines, and other medications for GAD, but hydroxyzine is not typically considered a first-line treatment 9.
- For adult patients with GAD, SSRIs and SNRIs represent the first-line psychopharmacologic treatment, while second-line pharmacotherapies include buspirone, benzodiazepines, and pregabalin 9.
- In pediatric patients with GAD, SSRIs should be considered the first-line pharmacotherapy, and psychotherapy can enhance antidepressant response 9.
Treatment Options for Panic Disorder
- Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are standard first-line pharmacologic treatments for PD, while hydroxyzine can be considered a third-line agent 10.
- Cognitive-behavioral therapy (CBT) is a strongly supported treatment for PD, and other options like serotonin multimodal agents, esketamine, and repetitive transcranial magnetic stimulation (rTMS) merit further investigation 10.