What is the efficacy of Hydroxyzine (Atarax) for treating anxiety?

From the Guidelines

Hydroxyzine is not the first-line treatment for anxiety, and cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitor (SSRI) medication are preferred options. According to the most recent and highest quality study 1, CBT is a diverse group of interventions targeted at the three primary dimensions of anxiety, and therapeutic interventions are individually tailored to illustrate connections among worries and fears, thoughts, and behaviors. The goal of structured CBT is to achieve meaningful symptomatic and functional improvement within 12 to 20 sessions.

Some key points to consider when treating anxiety include:

• CBT may be considered the first-line treatment for anxiety in children and adolescents, particularly for mild to moderate presentations 1
• SSRI medication is an alternative treatment consideration, particularly for more severe presentations or when quality CBT is unavailable 1
• Combination treatment (CBT and SSRI) may be a more effective short-term treatment for anxiety in children and adolescents than either treatment alone 1
• The choice of an anxiolytic should be informed by the adverse effect profiles of the medications, tolerability of treatment, and patient preference 1

In terms of medication, SSRI medication is generally preferred over hydroxyzine due to its efficacy and safety profile. However, hydroxyzine may be considered in certain cases, such as when SSRI medication is not effective or tolerated. It is essential to weigh the potential benefits and risks of hydroxyzine, including its sedative properties and potential interactions with other medications.

Ultimately, the treatment of anxiety should be individualized and based on a comprehensive assessment of the patient's symptoms, medical history, and preferences. A stepped care model, as recommended by the American Society of Clinical Oncology 1, can help tailor intervention recommendations to the individual patient's needs.

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

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) 3.
• Compared to other anxiolytic agents, such as benzodiazepines and buspirone, hydroxyzine was equivalent in terms of efficacy, acceptability, and tolerability 3.
• However, the included studies had a high risk of bias, and the small number of studies and overall small sample size limit the recommendation of hydroxyzine as a reliable first-line treatment for GAD 3.

Treatment Strategies for Anxiety Disorders

• Hydroxyzine is mentioned as an option for the treatment of anxiety disorders, including obsessive-compulsive disorder (OCD) and panic disorder (PD) 4, 5, 6.
• The first-line treatments for OCD include selective serotonin reuptake inhibitors (SSRIs) and clomipramine, while the recommended drugs for PD include SSRIs, tricyclic antidepressants (TCAs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) 4.
• Hydroxyzine can be considered a third-line agent for the treatment of PD, and it may be used in combination with other medications, such as antidepressants 7, 6.

Pharmacotherapy of Anxiety Disorders

• The current pharmacological treatments for anxiety disorders include SSRIs, SNRIs, azapirones, mixed antidepressants, antipsychotics, antihistamines (e.g., hydroxyzine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin) 5.
• Novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural remedies 5.
• However, there is a lack of randomized double-blind placebo-controlled trials for anxiety disorders, and few studies have compared novel treatments to existing anxiolytic agents 5.