From the Guidelines
The most effective non-addictive prescription medication for relaxation is typically considered to be buspirone (BuSpar). Buspirone is an anti-anxiety medication that works by affecting serotonin receptors in the brain without the sedative and addictive properties of benzodiazepines. It's usually prescribed at a starting dose of 5-7.5 mg twice daily, which can be gradually increased to 20-30 mg daily divided into multiple doses. Unlike benzodiazepines which work immediately, buspirone takes about 2-4 weeks of regular use to reach full effectiveness, so patience is required when starting this medication. Side effects are generally mild and may include dizziness, headaches, nausea, or nervousness. Buspirone is particularly useful for long-term management of anxiety and tension because it doesn't cause physical dependence or withdrawal symptoms. Other non-addictive options that physicians might consider include certain antidepressants like SSRIs or SNRIs (like venlafaxine) 1, which can help with anxiety but primarily treat depression and also require several weeks to become effective. However, the provided evidence 1 focuses on the use of antidepressants for pain management, highlighting their analgesic effectiveness and dosing strategies, such as starting with low doses of tricyclic antidepressants (e.g., amitriptyline, imipramine) and increasing as tolerated. Key points to consider when prescribing relaxation medications include:
- The potential for addiction and the importance of choosing non-addictive options
- The need for patience when starting certain medications, like buspirone, which can take several weeks to become fully effective
- The importance of individualized treatment plans, taking into account a patient's specific health factors and needs
- The role of alternative therapies, such as cognitive-behavioral therapy or mindfulness practices, which can be used in conjunction with medication to enhance relaxation and reduce anxiety.
From the FDA Drug Label
THE POTENTIATING ACTION OF HYDROXYZINE MUST BE CONSIDERED WHEN THE DRUG IS USED IN CONJUNCTION WITH CENTRAL NERVOUS SYSTEM DEPRESSANTS SUCH AS NARCOTICS, NON-NARCOTIC ANALGESICS AND BARBITURATES. The most effective prescription medication for relaxation that is non-addictive is hydroxyzine (PO) 2.
- Key benefits: hydroxyzine has a potentiating action when used with other central nervous system depressants, and it should be used with caution in patients with risk factors for QT prolongation.
- Important considerations: patients should be warned of the possibility of drowsiness and cautioned against driving a car or operating dangerous machinery while taking hydroxyzine.
From the Research
Non-Addictive Prescription Medications for Relaxation
The following medications have been studied for their efficacy in treating generalized anxiety disorder (GAD) without being addictive:
- Hydroxyzine: an anti-histamine medication that has been used in the treatment of anxiety 3, 4, 5
- Buspirone: an azapirone that is used to treat GAD without the risk of physical dependence or psychomotor impairment 6, 7, 5
Efficacy of Hydroxyzine and Buspirone
Studies have shown that:
- Hydroxyzine is more effective than placebo in treating GAD, with a significant difference in improvement on the Hamilton Anxiety Scale 3, 5
- Buspirone is also effective in treating GAD, with efficacy comparable to hydroxyzine and other anxiolytic agents 6, 7, 5
- Both hydroxyzine and buspirone have been found to be acceptable and tolerable, with a low risk of side effects compared to other anxiolytic agents 3, 7, 5
Comparison of Hydroxyzine and Buspirone
- Hydroxyzine and buspirone have been compared in a multicentre double-blind study, which found that both medications were more efficacious than placebo in treating GAD 5
- Hydroxyzine was found to be more effective than buspirone in improving cognitive symptoms of anxiety 4, 5
- Buspirone is considered a treatment of choice for GAD when prolonged therapy is indicated, due to its lack of physical dependence and psychomotor impairment 7