Biological perspectives: hydroxyzine for anxiety: another look at an old drug

Hydroxyzine (Vistaril, Atarax), a first-generation antihistamine, is a useful, venerable, although now slightly arcane medication in the tool belt of the thoughtful and experienced psychopharmacologist. It was launched on the pharmaceutical market in the US in 1956 and although known to be an effective anxiolytic, it was soon overshadowed by the more highly touted benzodiazepines that took the stage in the early 1960s. In recent years, the benzodiazepines have themselves been supplanted in the treatment of anxiety by less addictive agents such as the selective serotonin reuptake inhibitors, the serotonin and norepinephrine reuptake inhibitors, and yet still newer drugs. However, hydroxyzine continues to be an agent worthy of consideration for the treatment of various anxiety states and insomnia. Here, Dowben outlines the reasons, including that this medication presents with a fair amount of versatility, it works by blocking histamine H-1 receptors, and it has a relatively fast onset.