Acute symptomatic anxiety

Brief episodes of marked anxiety without a formal anxiety disorder diagnosis – typically a reaction to a specific event (medical procedure, exam, family crisis). First-line is non-pharmacological: breathing techniques, reassurance, brief psychotherapy support when needed. Drug therapy (hydroxyzine, less often benzodiazepines short-term) is reserved for marked symptoms impairing daily function, for no longer than 2–4 weeks.

ICD-10 F41.91 drug

Also known as: Acute anxiety state, Situational anxiety

Drugs used for this condition

BHydroxyzineSecond line · First-generation antihistamine with anxiolytic activityUsed in anxiety, emotional tension, and sleep disturbance linked to anxiety. Compared with benzodiazepines, it carries no dependence or abuse risk and can be used longer. NICE 2020 lists hydroxyzine as a second-line option in generalized anxiety disorder when SSRIs are unsuitable. Standard dose 25–100 mg daily in 2–3 divided doses; for acute episodes, single doses up to 100 mg. In patients over 65, start at the minimum dose given anticholinergic effects.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit