Atrarax for Anxiety and Sleep

[Better Days]

Dear Dr. Gould,

Our 26 year old son has suffered from mild symptoms of an apparently Bipolar II phase recently.  This includes ongoing anxiety symptoms.  



He was taken off of the SSRI Celexa (Citalopram) a month ago -- which he took for over a year.  He started on Lithium recently and is now taking 900 mg/day but, he has not yet reached the therapeutic level.  He does not want to risk taking any anti-psychotics.  He is taking Clonazepam (for about 2 years -- symptoms of PAD).  Sometimes he took 4 mg/day and now must reduce it to 2 mg/day and taper off gradually.  He has developed a tolerance to the Clonazepam.  



Currently, he has considerable trouble with sleeping – this is possibly amplified by the additional stress of University finals.  At times he uses Zopiclone to induce sleep.  We, as parents, and our son as well are very concerned and are considering other options and alternatives.



We read that Hydroxyzine (Atarax) has been used with success for the treatment of anxiety and sleeping disorders.  The only side effects listed were a dry mouth and merely initial drowsiness.  We understand it is an antihistamine.  How does this work and how does Hydroxyzine affect the brain?  We understand this medication is NOT addictive.  Can it be used instead of the Clonazepam and/or the Zopiclone?   What are the possible consequences of long term use of Hydroxyzine?  How does Hydroxyzine achieve a reduction in anxiety and how does it induce sleep compared to Zopiclone and Clonazepam?  



Thank you -- your advice will be appreciated.

[Roger Gould, M.D.]

I would like to give you the best advice I can, and that is not to take my medication advice on this matter.  There are so many variables to take into account with these choices, and these circumstances, that I would advise you to sit down with a psychopharmacologist, someone you trust or is recommended by your psychiatrist.  Its not just a matter of recommending, it involves monitoring as well.  YOur psychiatrist may be a psychopharmacologist, but if he is not, then seek a consultation.

[peacetrain]

I take 10 mg. of atarax at nites often, it does help quite a lot. My sister takes 25 mgs occassionally. I have taken it during the day for anxiety also, but it is dangerous when driving cause it does make u drousy. It is a very safe drug so my dr. tells me and i have taken it on and off for years. It was first prescribed for my daughter by her pediatritian when she was 9 for some lite sleeping problems. Thats how i came across it, i took one too that nite and it really does help. I have noticed though now that i've taken it for a while it doesn't work as well as it did, but i don't need it much anymore either.