Psychiatry & Medication

Antihistamines for Anxiety

 May 11, 2022

By  Natalie Kirilova

Medicinal Mushrooms

The Bottom Line

  • Antihistamine is a medication most often used for allergy symptoms, insomnia or cold treatments.
  • Certain antihistamines are occasionally used for other applications, such as anxiety.
  • Hydroxyzine is the most commonly prescribed antihistamine for anxiety.
  • Antihistamines are sometimes used for an anesthetic effect before or after surgery. 

What are antihistamines?

Antihistamines are medications used for allergies and symptoms caused by histamine, a chemical that exhibits allergic reactions. It helps to suppress the allergy trigger like pollen, dust or pet wool. Antihistamines are best for short-term treatment and can be taken for cold symptoms such as a runny nose, sneezing, congestion. Some patients consider them as on-demand medications when the onset of a certain season causes allergic reactions. A doctor can occasionally prescribe an antihistamine for anxiety or insomnia such as Hydroxyzine.

Hydroxyzine is the most commonly prescribed antihistamine for anxiety. Primarily, it is used to treat skin allergic reactions such as hives or itching in both adults and children. It works also by reducing the central nervous system activity based on which Hydroxyzine can function as a sedative medication to treat anxiety or help relax a patient before or after the surgery. 

Hydroxyzine is available in capsules, tablets, oral suspension or syrup. Hydroxyzine is also available in a generic form and the brand names are Atarax, Vistaril. 

Can antihistamines be taken for Anxiety? 

Hydroxyzine is the only medication from the group of antihistamines which can be used for anxiety relief associated with psychoneurosis. Hydroxyzine can also be taken for conditions where anxiety is manifested as a symptom. There is no evidence of its efficacy with long-term treatment. A physician should assess the usefulness of Hydroxyzine in every patients depending on the severity of anxiety, age or history of diseases.

Are antihistamines FDA approved for anxiety?

In 1956, the brand medication for Hydroxyzine, Atarax was first approved by the Food and Drug Administration (FDA) to treat allergy symptoms, however, the manufacturing has been discontinued in 2009. Accordingly, Hydroxyzine as an antihistamine for anxiety can be used only as an off-label medication when no other alternative or first-line medications are useful, they cause side effects or do not show efficacy in treatment.

What research supports antihistamines for anxiety? 

  • A study on the comparison of classic vs brand new classes of antihistamines for anxiety has been conducted where 92 people took Cetirizine, Hydroxyzine, Desloratadine, Levocetirizine, Rupatadine for one month. They were assessed on the first and last days of the study. The last three, Desloratadine, Levocetirizine, Rupatadine reported lower scores on depression, anxiety, mood, and sleep disturbances. Both classes improved nocturnal sleep.
  • Hydroxyzine is a sedative antihistamine for anxiety which was licensed for the short-term application in adults only. The safe application of Hydroxyzine is at 50-100mg dosage 4 times per day. Doctors support Hydroxyzine use for generalized anxiety disorder (GAD) treatment for one month.
  • The research on Hydroxyzine efficacy over the placebo was conducted over 39 studies with 884 patients with GAD. The results confirmed higher efficacy of Hydroxyzine, its tolerance, acceptability. Some patients developed drowsiness as a side effect.
  • Hydroxyzine for anxiety with Buspirone were both compared with the placebo. 244 patients followed the treatment for 4 weeks. 31 patients decided to discontinue the treatment. The results showed that both medications were responding to anxiety symptoms, and showed more effect over the placebo. Thus, Hydroxyzine was considered useful for generalized anxiety disorder (GAD).

What do experts say about antihistamines for anxiety?

David J. Nutt, neuropsychopharmacologist specialising in the research of drugs, and James C. Ballenger MD., neurologist both write “Hydroxyzine has also been widely used to treat anxiety in conjunction with bodily symptoms in the context of psychosomatic syndromes, because of its beneficial effect on somatized anxiety, in particular cardiac anxiety. Hydroxyzine is more effective in treating anxiety of neurotic nature, than in relieving psychotic anxiety.”

What are the possible side effects?

There are potential side effects when taking Hydroxyzine:

  • Drowsiness;
  • Nausea;
  • Low appetite;
  • Nervousness;
  • Dry mouth;
  • Dizziness;
  • Mood swings in children;
  • Confusion;
  • Blurred vision.

If the antihistamine you are taking is linked to drowsiness, and you operate heavy machinery or otherwise need to be alert, speak to a doctor about taking this medication. 

Hydroxyzine may be contraindicated for use in patients with glaucoma, liver/kidney diseases, high blood pressure, enlarged prostate. Inform your doctor about the history of these diseases and your full medical history. 

Many antihistamines such as Cetirizine, chlorphenamine are well-tolerated and can be used in pregnant and nursing women. 

Hydroxyzine is not recommended for use in nursing mothers, as it is unknown whether it excretes into breast milk. Also, Hydroxyzine should not be taken during the first trimester of pregnancy. Always speak to your doctor about taking this medication while pregnant.

Do antihistamines have interactions with other medications? 

An antihistamine Hydroxyzine taken with other medications may cause side effects or have interactions with other medications. It is prohibited to combine treatments without a doctor’s approval. 

Monoamine oxidase inhibitors (MAO), Anticholinergics drugs, CYP2D6 Inhibitors, Radioactive Iodide interacted with Hydroxyzine or other antihistamines for anxiety may lead to severe or fatal consequences. 

Do not take Hydroxyzine with antidepressants, cold (with antihistamine in the composition) and indigestion medications without your doctor’s approval.

Do not drink alcohol when you are on the anxiety treatment with Hydroxyzine, it may alter the efficacy, and make you drowsy.

Do not stop the intake or change the dosage of Hydroxyzine at your sole discretion.

How to take antihistamines?

Hydroxyzine for anxiety dose is prescribed and adjusted only by a doctor depending on the severity of symptoms, age, and individual response. Hydroxyzine is available in tablets to take by mouth with or without food up to 4 times per day. Do not break or chew a tablet. 

A doctor may prescribe Hydroxyzine solution or syrup for anxiety which one should measure using a measuring spoon prior to intake. 

If you skip a dose of Hydroxyzine, address this concern to your doctor. Do not take double of the prescribed dose to catch up with the regimen.

Take Hydroxyzine as directed by your doctor. 

Are there alternatives to antihistamines?

Prescription medications as alternatives to Antihistamines for Anxiety 

Hydroxyzine or antihistamines for anxiety are medications that are only fit for certain type of patients. They are prescribed in exclusive situations when the first-line treatment was not responding or caused many side effects. For alternative anxiety treatment Hydroxyzine, a doctor may prescribe the following medications:

  • Trazodone
  • Klonopin
  • Meclizine
  • Melatonin
  • Aniracetam
  • L-theanine
  • Nicotine
  • L-tyrosine
  • Theacrine
  • Ashwagandha
  • Bacopa Monnieri
  • Noopept
  • B Vitamins

There are various alternatives. If you’d like to learn more about whether antihistamines, another medication or treatment modality is right for you, we recommend that you speak with a licensed professional. Here are the best online psychiatry platforms so you can speak with someone right away!

Therapy as an Alternative to Antihistamines 

Learn more about different therapy options for anxiety  here

Energy & Holistic Modalities as an Alternative to Antihistamines 

Learn more about different energy & holistic modalities for anxiety here

Tech & Devices as Alternative Treatments to Antihistamines

Learn more about tech & devices for anxiety  here

Disclaimer: This website does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on our Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Natalie is a writer with a focus in medical research with over 10 years of experience

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