Hydroxyzine is a forgotten anti-anxiety agent.  It is probably my favorite anti-anxiety agent. It isn't addictive, has a low level of side-effects, and is quite inexpensive.  When it doesn't work, I usually try an anti-depressant for anxiety.  

Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine HCl (Atarax).  While Vistaril was marketed for allergies and Atarax for anxiety, there appears to be little difference.  The pamoate version is much less expensive at the present time.

Hydroxyzine As Good As Benzodiazepine for Anxiety: In a DB PC study of 343 patients with Generalized Anxiety Disorder, patients were treated for 12 weeks with 50 mg/day or placebo or bromazepam 6 mg/day. Hydroxyzine was better than placebo on HAM-A with a 12 point vs. a 9 point decrease in anxiety from 20 or above. There was more drowsiness with the benzodiazepine, but no other significant side-effects noted. Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study. Llorca PM, Spadone C, Sol O, Danniau A, Bougerol T, Corruble E, Faruch M, Macher JP, Sermet E, Servant D. Hopital Gabriel Montpied, Clermont-Ferrand, France, J Clin Psychiatry 2002 Nov;63(11):1020-7

Hydroxyzine Helps Anxiety Better than Buspirone: In a 133-patient, 4-week DB PC French study with hydroxyzine 50 mg/day, sleepiness most common side-effect. Ferrari, Paris, Encephale ’94;20:785; Also, Arch Gen Psych ’67;16:471

Generalized Anxiety: Hydroxyzine Did Better than Buspirone which was Better than Placebo: In a DB PC study of buspirone 5 b.i.d.and 10 hs. vs. hydroxyzine 12.5 b.i.d. and 25 hs. vs. placebo of 244 patients for 4 weeks, dropout were equal in all three groups and small. Hydroxyzine did significantly better than placebo on HAM-A. Both buspirone and hydroxyzine were better than placebo on CGI and self-rating. A multicentre double-blind comparison of hydroxyzine, buspirone and placebo in patients with generalized anxiety disorder. Lader M, Scotto JC. Psychopharmacology (Berl) 1998 Oct;139(4):402-6

Hydroxyzine Helps Lorazepam Withdrawal: In a DB PC study, hydroxyzine 25 mg b.i.d. helped lorazepam withdrawal.  Lyon, Encephale ’97;23:290

Hydroxyzine Better Than Lorazepam for Anxiety: In a DB PC 4 week multicenter study of hydroxyzine 100 mg t.i.d. (or 100 mg/d?) vs. lorazepam 4 mg t.i.d. (or 4 mg/d?). Hydroxyzine did better on five measures and was faster acting. Marseilles, Encephale ’95;21:147. Also, one study found memory difficulty after one dose of lorazepam but not with hydrolyzine in 12 elderly in DB. Acca Psych Belg ’92;92:370