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Medications are tools not answers. All drugs have multiple effects most of which have received little or no study at all. We are not fortune-tellers. It's impossible to predict exactly what effects a drug will have in a given individual.

Hydroxyzine is an old drug, with antihistaminic, anticholinergic, and some degree of 5HT2a antagonism. It can have moderate anti-anxiety effect, and may reduce discomfort of opioid withdrawal symptoms. However, some people respond poorly, or even become agitated with use of such agents.

While SSRIs block presynaptic 5HT reuptake, this is also known to be a transient effect. Antidepressant action is associated with "downstream" intracellular neuronal changes that are extremely complex and incompletely understood. Specifically, 5HT2a effects are diffuse and connection to particular symptoms tenuous at best. A quick look here should illustrate this point: https://en.wikipedia.org/wiki/5-HT2A_receptor

Pragmatically, if a medication produces troublesome effects, don't try too hard to "explain" the problem, but definitely don't suffer in silence. Talk it over with the doctor and try other approaches. Psychotherapies can be effective. I agree, it's not an "either-or" situation, rather "all-of-the-above". By all means use the whole range of effective and tolerable tools at your disposal.




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