Does hydroxyzine (an antihistamine) help with anxiety?

From the Guidelines

Hydroxyzine can be an effective option for managing anxiety, particularly in the short-term, as evidenced by its approval for anxiolytic use in both Europe and the United States 1.

Key Points to Consider

• Hydroxyzine is a sedative antihistamine that can help reduce feelings of nervousness and tension by affecting histamine receptors in the brain.
• It is available in tablets and syrup, with few contraindications in children, making it a versatile option for various patient groups 1.
• The medication begins working within 15-30 minutes after taking it and can cause drowsiness, which is why it's often taken at bedtime when anxiety interferes with sleep.
• Common side effects include drowsiness, dry mouth, and dizziness, but it is not habit-forming like benzodiazepines, potentially making it a safer option for some patients.
• For chronic anxiety disorders, other treatments like SSRIs or therapy approaches are typically recommended as first-line treatments, with hydroxyzine serving as an as-needed supplement for breakthrough anxiety symptoms 1.

Clinical Considerations

• Hydroxyzine should not be combined with alcohol or other central nervous system depressants.
• Its use in long-term anxiety management may not be appropriate, highlighting the need for careful patient selection and monitoring.
• The choice of hydroxyzine over other anxiolytics, such as benzodiazepines, should consider the patient's age, medical history, and the potential for drug interactions or side effects.
• Recent guidelines and studies emphasize the importance of a comprehensive treatment plan that may include psychological therapies, lifestyle modifications, and, when necessary, pharmacological interventions like hydroxyzine 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 label states it is used for anxiety associated with psychoneurosis and as an adjunct in organic disease states where anxiety is present.
• Key uses include relief of anxiety and tension, as well as management of pruritus due to allergic conditions. The effectiveness of hydroxyzine for long-term use (more than 4 months) has not been assessed by systematic clinical studies 2.

From the Research

Efficacy of Hydroxyzine in Anxiety Treatment

• Hydroxyzine has been shown to be effective in treating generalized anxiety disorder (GAD) in several studies 3, 4, 5.
• A study published in 2010 found that hydroxyzine was more effective than placebo in treating GAD, with an odds ratio of 0.30 (95% CI 0.15 to 0.58) 3.
• Another study published in 1998 found that hydroxyzine was superior to placebo in reducing anxiety symptoms, with efficacy maintained throughout the 4-week treatment period 4.
• A 3-month double-blind study published in 2002 found that hydroxyzine was effective in treating GAD, with a mean change in Hamilton Rating Scale for Anxiety (HAM-A) scores of -12.16 +/- 7.74 compared to -9.64 +/- 7.74 for placebo (p = 0.019) 5.

Comparison with Other Anxiolytic Agents

• Hydroxyzine has been compared to other anxiolytic agents, such as benzodiazepines and buspirone, in several studies 3, 4, 5.
• A study published in 2010 found that hydroxyzine was equivalent to benzodiazepines and buspirone in terms of efficacy, acceptability, and tolerability 3.
• Another study published in 1998 found that hydroxyzine demonstrated greater and more rapid cognitive improvement compared to lorazepam 4.

Safety and Tolerability

• Hydroxyzine has been shown to be generally safe and well-tolerated in several studies 3, 4, 5, 6.
• A study published in 2021 found that hydroxyzine was not associated with any significant adverse events, with a similar safety profile to placebo 6.
• However, another study published in 2010 found that hydroxyzine was associated with a higher rate of sleepiness/drowsiness compared to active comparators (OR 1.74,95% CI 0.86 to 3.53) 3.

Specific Populations and Settings

• Hydroxyzine has been studied in various populations and settings, including prehospital patients with acute pain 6 and patients with depressive disorders 7.
• A study published in 2021 found that hydroxyzine did not reduce pain or anxiety in prehospital patients with acute severe pain 6.
• Another study published in 1996 found that hydroxyzine did not antagonize the reversal of helpless behavior by specific serotonin reuptake inhibitors, suggesting that it may be a suitable anxiolytic agent to co-administer with antidepressants 7.