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Letter to the Editor

Successful Treatment With Hydroxyzine of Acute Exacerbation of Panic Disorder in a Healthy Man: A Case Report

Joseph W. Iskandar, DO; Benjamin Griffeth, MD; and Christian Rubio-Cespedes, BS

Published: June 16, 2011

Successful Treatment With Hydroxyzine of Acute Exacerbation of Panic Disorder in a Healthy Man: A Case Report

To the Editor: In a given year, approximately 6 million American adults aged 18 years or older have panic disorder.1,2 To the best of our knowledge, this is the first report to document the successful treatment of acute exacerbation of panic disorder with hydroxyzine in a healthy adult.

Case report. Mr A, a 25-year-old man with a history of panic disorder, presented in 2010 to the emergency department complaining of chest pain, tachycardia, palpitations, hyperventilation, shortness of breath, sweating, nausea, and vomiting. Moreover, he reported derealization, a sense of doom, and constant fear of having another panic attack. Mr A stated that he had been having panic attacks about 3 or 4 times daily for the previous week. Myocardial infarction was ruled out. Blood workup was inconclusive for any other medical cause.

Mr A had been on venlafaxine 75 mg/d orally for the previous 6 months. He had taken paroxetine 40 mg/d orally with no improvement for the 6 months prior to starting venlafaxine. Past medical, surgical, and family histories were not significant for any major illnesses. He was employed and single and smoked half a pack of cigarettes daily, but had no history of alcohol or illegal drug use. The patient denied having any psychosocial stressors. Physical examination findings revealed no abnormalities.

Mr A was admitted to the acute psychiatry unit for observation. Upon admission to the unit, hydroxyzine 25 mg 3 times daily was started with no other changes in medication or therapy. The patient received prompt relief, and there were no further panic attacks during his 3-day admission or his 1-month follow-up.

To the best of our knowledge, there are no published cases of successful treatment of acute exacerbation of panic disorder with hydroxyzine in healthy adults. There has been clear evidence of the anxiolytic efficacy of hydroxyzine. In a controlled trial in generalized anxiety disorder patients, hydroxyzine demonstrated greater and more rapid cognitive improvement compared to lorazepam.3 Moreover, it has also shown a lack of organ toxicity and an absence of dependency.

As reported in our case, an acute exacerbation of panic disorder was effectively managed by hydroxyzine in a healthy adult. If practitioners recognize this association, extensive use of benzodiazepines may be prevented.


1. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617-627. PubMed doi:10.1001/archpsyc.62.6.617

2. US Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02). Population Division, US Census Bureau Release Date: June 9, 2005. Accessed February 24, 2011.

3. Ferreri M, Hantouche EG. Recent clinical trials of hydroxyzine in generalized anxiety disorder. Acta Psychiatr Scand Suppl. 1998;393(s393):102-108. PubMed doi:10.1111/j.1600-0447.1998.tb05974.x

Joseph W. Iskandar, DO

Benjamin Griffeth, MD

Christian Rubio-Cespedes, BS

Author affiliations: Carilion Clinic, Virginia Tech Carilion School of Medicine, Psychiatry Residency Program, Roanoke (Dr Iskandar); and Edward Via College of Osteopathic Medicine, Blacksburg (Dr Griffeth and Mr Rubio-Cespedes), Virginia.

Potential conflicts of interest: None reported.

Funding/support: None reported.

Published online: June 16, 2011 (doi:10.4088/PCC.10l01126).

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