Hydroxyzine for Anxiety in Oregon and Washington

What It Is

Hydroxyzine is an antihistamine that's FDA approved for anxiety. Think of it as Benadryl's stronger prescription cousin. Comes in two forms: hydroxyzine pamoate (Vistaril) and hydroxyzine HCl (Atarax). They're essentially the same drug, just different salt forms.

Not a controlled substance, not addictive, and cheap. Comes in capsules or tablets, typical doses range from 25mg to 100mg.

What It Does

Hydroxyzine reduces anxiety and causes sedation through antihistamine effects. It calms you down and makes you drowsy. Used for generalized anxiety, as-needed anxiety relief, and sometimes for sleep because of how sedating it is.

It's not as fast-acting or powerful as benzodiazepines, but it's also not addictive and doesn't cause dependence. For mild to moderate anxiety, it can work pretty well.

How It Works

Hydroxyzine blocks histamine receptors in your brain. Histamine is involved in wakefulness and arousal, so blocking it causes sedation. It also has some effects on serotonin and other neurotransmitter systems that contribute to its anti-anxiety properties.

The mechanism is completely different from benzos or SSRIs, which is why it has a different side effect profile and different risks.

What It Feels Like When It's Working

You take it, within 30 minutes to an hour you start feeling drowsy and relaxed. Anxiety eases. You feel calmer but also sluggish and tired. Your thinking might feel a bit foggy.

If you're taking it for sleep, it'll knock you out pretty effectively. If you're taking it for anxiety during the day, the drowsiness can be a problem unless you're okay with being less alert.

The sedation is real. Most people can't function normally on hydroxyzine the way they could on an SSRI. You're essentially choosing between anxiety and being useless.

Common Side Effects

Drowsiness and sedation are the most common side effects and also the main therapeutic effect. You will be tired. Plan accordingly.

Dry mouth is extremely common. Antihistamines do this. Drink water constantly.

Dizziness and feeling foggy or mentally slow.

Headache can happen.

Some people feel hung over or groggy the next day, especially at higher doses.

Weight gain is possible but less common than with some other anxiety meds.

Rare but serious: QT prolongation (heart rhythm issue). This is uncommon but worth knowing about if you have heart problems or take other medications that affect heart rhythm.

What It Looks Like When It's Not Working

You're taking hydroxyzine and your anxiety is still there. Or the sedation is so strong that you can't function even though your anxiety is better.

Sometimes the dose needs adjustment. Sometimes hydroxyzine just isn't strong enough for your level of anxiety. For severe anxiety or panic disorder, you probably need something more powerful.

If you're so drowsy you can't stay awake or function during the day, the medication might be helping anxiety but causing too many problems to be useful.

Timeline for Noticing Effects

Hydroxyzine works fairly quickly. You'll feel effects within 30 minutes to an hour. Peak effects happen around 2 hours after taking it. Effects last 4 to 6 hours typically.

Some people take it as needed for anxiety. Others take it on a schedule. Because it's so sedating, a lot of people take it at night for both anxiety and sleep.

Real Talk About Hydroxyzine in the Pacific Northwest

Hydroxyzine is prescribed constantly because providers like having a non-addictive anxiety medication option that's not a controlled substance. It works reasonably well for mild to moderate anxiety, it's cheap, and patients can't get dependent on it like they can with benzos.

The sedation is the main issue. It's strong enough that most people can't take it and function normally. If you need anxiety relief during the day and you need to be alert and productive, hydroxyzine probably isn't great. If you're taking it at night for anxiety and sleep, the sedation is actually a benefit.

Our team throughout Oregon and Washington (Portland, Salem, Eugene, Spokane, Vancouver, Bellingham, Corvallis) prescribes hydroxyzine fairly often, especially for people who have substance use history and can't safely take benzos, or for people who want to avoid controlled substances.

It's not as effective as benzos for severe anxiety, but it's safer long-term. No addiction, no dependence, no withdrawal if you stop. The worst that happens is your anxiety comes back.

Generic hydroxyzine is extremely cheap, like a few dollars for a month's supply. Insurance almost always covers it without hassle.

Some people use it as needed before stressful situations. Some take it regularly. Some take it just at night for sleep and anxiety. The sedation makes it flexible for different uses as long as you're okay with being drowsy.

Mixing hydroxyzine with alcohol increases sedation significantly. Both make you drowsy and impair coordination. The combination can be dangerous. Don't do it.

If you're taking other sedating medications (sleep meds, pain meds, other antihistamines), adding hydroxyzine increases the risk of excessive sedation.

The dry mouth thing is annoying but manageable. Sugar-free gum, water, saliva substitutes can help.

If you have heart problems or take medications that affect heart rhythm, your provider needs to know before prescribing hydroxyzine. The QT prolongation risk is small but real.

Anxiety Treatment Throughout Oregon and Washington

LiveWell Psychiatry and Men's Health provides anxiety treatment for patients throughout Oregon and Washington, including Portland metro, Vancouver and Clark County, Salem, Eugene, Corvallis, Bend, Spokane, Tri-Cities, and surrounding communities. If you're dealing with anxiety and want a non-addictive medication option, we can evaluate whether hydroxyzine or another approach makes sense.

Hydroxyzine is a decent middle-ground option. Not as powerful as benzos, not as well-tolerated for daytime use as SSRIs, but non-addictive and effective enough for mild to moderate anxiety. The sedation is a feature if you're taking it for sleep, a bug if you need to function during the day. But for the right situation and the right person, it works.