I have used Vistaril/hydroxyzine as an "add-on" anxiety med and also to help with anxiety when I was tapering down an antidepressant.

I took a fairly low dose (25-50 mg/day.) It helped more with anxiety than I expected. I took it every day for a few months last year and when I was taking it regularly, the side effects lessened (headache in the morning, dry eyes & mouth, drowsiness.)

It's on the list of meds that was published recently that are supposed to increase the risk of dementia if you take it for years. So is clonazepam, though.

I didn't drive while I was taking it. I'm not sure how it might affect those skills.

It worked better than I expected for a PRN-type anxiety medication. I think it would probably take a high dose to work for very severe anxiety, but I'd find that 25 or 50 mg would work for my withdrawal anxiety.

I wish I knew what would get rid of the headache that I got from it, though. It's a very common side effect, and none of the OTC headache meds I tried ever helped it at all.