From the Guidelines
Hydroxyzine is the most effective antihistamine for anxiety, as it is specifically approved for anxiolytic use and has been shown to be effective in reducing anxiety symptoms. According to the study published in the European Journal of Nuclear Medicine and Molecular Imaging 1, hydroxyzine is a sedative antihistamine that is available in tablets and syrup and has few contraindications in children. It is typically prescribed at doses of 25-50mg taken up to four times daily as needed for anxiety symptoms.
Key Points to Consider
- Hydroxyzine works quickly, usually within 30 minutes, and can be used on an as-needed basis rather than taken continuously.
- It helps reduce anxiety by blocking histamine receptors in the brain and increasing serotonin levels, which promotes calmness.
- Unlike benzodiazepines, hydroxyzine is non-addictive and doesn't cause withdrawal symptoms, making it suitable for longer-term use when necessary.
- Side effects may include drowsiness, dry mouth, and mild dizziness, which typically improve with continued use.
- It's essential to avoid alcohol while taking hydroxyzine as this can increase sedation, as noted in the study published in the Journal of Allergy and Clinical Immunology 1.
Comparison with Other Antihistamines
- While other antihistamines like diphenhydramine (Benadryl) have mild anti-anxiety effects, hydroxyzine is specifically approved for anxiety treatment and tends to be more effective for this purpose.
- Second-generation antihistamines are generally preferred over first-generation antihistamines for the treatment of allergic rhinitis, but hydroxyzine is a first-generation antihistamine that is effective for anxiety treatment.
Important Considerations
- Older adults are more sensitive to the psychomotor impairment promoted by first-generation antihistamines, and the use of hydroxyzine should be approached with caution in this population, as noted in the study published in the Journal of Allergy and Clinical Immunology 1.
- Concomitant use of other CNS-active substances, such as alcohol, sedatives, hypnotics, or antidepressant medication, may further enhance performance impairment from antihistamines.
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. The best antihistamine for anxiety is hydroxyzine (PO), as it is indicated for the symptomatic relief of anxiety and tension associated with psychoneurosis.
- Key points:
- Useful for anxiety and tension associated with psychoneurosis
- Can be used as an adjunct in organic disease states with anxiety
- Long-term use (more than 4 months) has not been assessed by systematic clinical studies 2
From the Research
Antihistamines for Anxiety
- Antihistamines are not typically considered a first-line treatment for anxiety, but some studies suggest that certain antihistamines may have anxiolytic effects 3.
- Hydroxyzine, a diphenylmethane derivative with antihistamine properties, has been shown to be effective in reducing anxiety in some studies 3.
Comparison to Other Anxiolytics
- Benzodiazepines are commonly used to treat anxiety, but they can have significant side effects and may be associated with dependence and withdrawal 4, 5.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are also commonly used to treat anxiety, and may be effective for long-term management 6, 7.
- A meta-analysis found that benzodiazepines may be more effective than SSRIs and SNRIs for short-term treatment of generalized anxiety disorder, but may have more side effects 5.
Specific Antihistamines for Anxiety
- Hydroxyzine has been shown to be effective in reducing anxiety in some studies, and may be a useful alternative to benzodiazepines or SSRIs in certain cases 3.
- However, more research is needed to fully understand the efficacy and safety of antihistamines for anxiety, and to determine which specific antihistamines may be most effective.