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May 13, 2021
4 min read

Hydroxyzine for anxiety: how effective is it?

Hydroxyzine in the right dose can help calm nerves and treat anxiety. Unlike some anti-anxiety medications, hydroxyzine is not addictive. The drug comes with potential side effects, however.

felix gussonerob roy britt

Reviewed by Felix Gussone, MD

Written by Robert Roy Britt

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Hydroxyzine is a prescription-only drug that is one of several medications that can help with anxiety. The medication is generally safe and effective at relieving anxiety symptoms, though not without several mild and even a few potential severe side effects. The Food & Drug Administration (FDA) has approved it for the treatment of general anxiety disorder, or GAD.

Does hydroxyzine help with anxiety?

Hydroxyzine is an antihistamine, so it blocks the effects of histamines, which are part of the body’s immune system. You probably know antihistamines as drugs which treat hay fever and other allergies.

It’s not known exactly how it works for anxiety, but when prescribed in adults or children, hydroxyzine decreases activity in the brain, having a calming effect. It’s also used as a sedative before and after anesthesia, and it can treat some allergic skin reactions (National Center for Biotechnology Information, 2021). The Food & Drug Administration has determined hydroxyzine to be useful and safe when used as directed (Garakani, 2020).

In a study of 334 people diagnosed with general anxiety disorder, hydroxyzine worked better than a placebo, serving as an effective alternative to bromazepam—a medication that’s part of a class of drugs (benzodiazepines or “benzos”) often prescribed for GAD (Llorca 2002). A subsequent study again found hydroxyzine better than a placebo, and the results suggested it “may be similar in efficacy to both benzodiazepine and buspirone, another anti-anxiety medication (Rudolph, 2020). 

There are advantages and disadvantages with hydroxyzine compared to other anti-anxiety medications. Unlike lorazepam (brand name Ativan) and other benzodiazepines like alprazolam (brand name “Xanax”), hydroxyzine is not considered addictive (National Alliance on Mental Illness, 2016). But over time, people tend to develop tolerance to antihistamines like hydroxyzine, rendering them less effective (Garakani, 2020).

Doctors determine hydroxyzine dosage

Hydroxyzine is sold under several brand names (Vistaril; Orgatrax)  and is also available as a generic. It is taken orally as a liquid, capsule, or tablet. You can take it daily or as needed, but the dose and timing should all be worked out by your healthcare provider.

The dose depends on someone’s diagnosis and may change over time, but a typical dosage for an adult with anxiety might be anywhere between 25 to 100 milligrams, up to four times daily. Children are prescribed much less (Mayo Clinic, 2021).


Hydroxyzine side effects and precautions

Hydroxyzine can have serious side effects that require immediate medical attention, including seizures, trembling or shaking, rashes, or pus-filled blisters. Less serious side effects include dry mouth, constipation, confusion, drowsiness, and dizziness or headaches. The drug can interact negatively with a range of other medications. Pregnant or breastfeeding women should not take hydroxyzine (FDA, 2014). 

Do you have anxiety or anxiety disorder?

Before prescribing any medication, a healthcare provider will want to know if your anxiety rises to the level of a clinical diagnosis.

It’s normal for any human to experience anxiety now and then, as we worry about the challenges of life and the many stressors that are thrown at us. 

However, if anxiety becomes extreme or constant, causing excessive worry on a daily basis even as you sense that the worries are overblown, you might have general anxiety disorder or GAD. General anxiety disorder is marked by the following symptoms (National Institute of Mental Health, 2016):

  • Difficulty relaxing or concentration
  • Trembling or twitching
  • Sleep problems
  • Irritability

Anxiety is quite common. In the United States, anxiety disorders affect about one in five of adults per year, while 31% are diagnosed with an anxiety disorder at some point in life (National Institute of Mental Health, 2017). 

Other treatments for anxiety

If you are diagnosed with an anxiety disorder, a psychiatrist or other healthcare provider will typically prescribe medications and/or cognitive behavioral therapy, both of which have been shown to improve quality of life for people with GAD (Bandelow, 2017).

If you’re just experiencing anxiety now and then, and you think it’s manageable, there are several potential remedies. Breathing exercises—super easy to do—are known to reduce anxiety (Harvard Health Publishing, 2020). 

More generally, your lifestyle can have a strong effect: Staying physically active and eating and sleeping well are all linked to lower anxiety levels (National Institute of Mental Health, 2016). 

If you’re feeling a little anxious right now, stop and take a deep breath. Literally. That just might be a great first step to relieve your anxiety. If that doesn’t help—or if you feel like nothing will—it’s time to see a healthcare provider to find out what’s behind your stress and angst and what can be done about it. 

Armed with all this information, you’re ready to ask a physician or psychiatrist if hydroxyzine would be an appropriate part of any treatment you’re prescribed.

References

  1. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelow. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/
  2. U.S. Food and Drug Administration (FDA) (2017). Vistaril. Retrieved May 10, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/011459s048%2C011795s025lbl.pdf
  3. Garakani A, Murrough JW, Freire RC, et al. Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Front Psychiatry. 2020;11:595584. Published 2020 Dec 23. doi:10.3389/fpsyt.2020.595584. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786299/
  4. Harvard Health Publishing (2020) Relaxation techniques: Breath control helps quell errant stress response https://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-errant-stress-response
  5. Llorca PM, Spadone C, Sol O, Danniau A, Bougerol T, Corruble E, Faruch M, et al. Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study. J Clin Psychiatry. 2002 Nov;63(11):1020-7. doi: 10.4088/jcp.v63n1112. PMID: 12444816. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12444816/
  6. Mayo Clinic, Hydroxyzine https://www.mayoclinic.org/drugs-supplements/hydroxyzine-oral-route/proper-use/drg-20311434?p=1
  7. MedlinePlus (U.S. National Library of Medicine) (2017) Hydroxyzine https://medlineplus.gov/druginfo/meds/a682866.html
  8. National Center for Biotechnology Information (2021). PubChem Compound Summary for CID 3658, Hydroxyzine. Retrieved May 10, 2021 from https://pubchem.ncbi.nlm.nih.gov/compound/Hydroxyzine
  9. National Alliance on Mental Illness (2016) Hydroxyzine (Vistaril, Atarax) https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Hydroxyzine-(Vistaril-Atarax)
  10. National Institute of Mental Health (2016) Generalized Anxiety Disorder: When Worry Gets Out of Control. Retrieved from https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/
  11. National Institute of Mental Health (2017) Any Anxiety Disorder. Retrieved from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml
  12. Rudolph, Michael MD; Liegl, Sarah MD In adults with generalized anxiety disorder, is hydroxyzine superior to placebo in reducing anxiety symptoms?, Evidence-Based Practice: August 2020 – Volume 23 – Issue 8 – p 42-43 doi: 10.1097/EBP.0000000000000713. Retrieved from https://journals.lww.com/ebp/Citation/2020/08000/In_adults_with_generalized_anxiety_disorder,_is.36.aspx