On November 20, 2023, the World Health Organization’s (WHO) 2023 (Third Edition) Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological, and substance use disorders introduced revised guidelines. The mhGAP guideline supports countries to strengthen their capacity to deal with the growing burden of mental, neurological, and substance use (MNS) conditions and narrow the treatment gap.
This new edition includes 30 updated and 18 new recommendations, alongside 90 pre-existing recommendations. This is the third iteration of the guideline and reflects 15 years of investment in the mhGAP program. The revised recommendations ensure that mhGAP continues to offer high-quality, timely, transparent, and evidence-based guidance to support non-specialist health workers in low-income and middle-income countries in providing treatment and care to individuals with MNS conditions.
Their findings regarding benzodiazepines are summarized below. The complete 2023 guidelines are available here.
Anxiety Disorders
(see page 25 of the guideline)
The World Health Organization’s new recommendation strongly discourages benzodiazepines for anxiety disorders, stating:
Benzodiazepines are not recommended for the treatment of adults with generalized anxiety disorder (GAD) and/or panic disorder. For emergency management of acute and severe anxiety symptoms, benzodiazepines may be considered but only as a short-term (3–7 days maximum) measure.
The WHO cautions that benzodiazepines carry a risk of dependence. They stress that benzodiazepines shouldn’t be commonly prescribed for anxiety or distress; instead, they should be used in specific cases of acute and severe anxiety or distress where other treatments haven’t worked or aren’t available. They highlight the importance of obtaining informed consent before prescribing and encourage a gradual discontinuation process.
They also point out that there are research gaps—a limited number of studies on the long-term effectiveness and safety of benzodiazepines—and indicate that further research would help to quantify the risks of longer-term use.
Child and Adolescent Mental Disorders (CAMH)
(see page 43 of the guideline)
A new recommendation by the WHO states that since the harms of the intervention outweigh the benefits, a strong recommendation is made against use of pharmacological interventions for children and adolescents with anxiety disorders.
The justification for this recommendation comes from evidence in one meta-analysis, which showed no significant difference between all tricyclic antidepressants (pooled) and benzodiazepines when compared to pill placebo for improving anxiety symptoms. Group SSRIs and benzodiazepines had significantly more people stopping the treatment due to adverse effects compared to those receiving the placebo pill.
Epilepsy
(see pages 76-79 of the guideline)
The World Health Organization’s guidelines mention that about 30–40% of adults with established status epilepticus don’t respond to initial benzodiazepine treatment. These individuals require additional treatment with other intravenous anti-seizure medicines (ASMs). The guidelines caution that using phenobarbital and diazepam infusion carries the potential risk of sedation and respiratory depression, especially if used after benzodiazepines. WHO also found that, like adults, 30-40% of all children do not respond to initial treatment with benzodiazepines. The WHO’s recommendations on epilepsy are conditional and based on low to moderate certainty of evidence.
Greetings,
This is…Disappointing. I’ve got fairly severe anxiety, particularly nightmares, and I have been taking Lorazepam for over ten years without any negative side-effects whatsoever, backed by a mainline medication (Risperdal). It’s enabled me to live a full life. No reason for this change in policy is cited other than dependence, but to me that sounds like a warning to be dependent on oxygen. The medication corrects a chemical imbalance in my brain. Why shouldn’t people have access to medication that allows them to walk forward rather than live in past trauma? Because they *might* develop a “dependence” on it? On the thing that fixes the broken chemical production in their brain?
I mean, really think about it. “You’d best be careful, you might get addicted to food!” sounds pretty much like what I’m hearing, here.
My warmest regards,
–Jesse Pohlman
I would like you to know that the Benzos gave me a quality of life for 14 years until they turned on me. I didn’t have any negative effects on it either. One day my panic started getting bad and i started to develop tolerance. I’ve now been bedbound for 4 years. I never thought this would be my life at 34 but this is what this drug did to me.
Hi! I understand you have benefited, but I must point out that, despite billions spent on research, there is no scientific evidence supporting the existence of chemical imbalances. The concept is considered outdated marketing lingo.
There is no chemical imbalance. The drug doesn’t correct a chemical
Imbalance. We have panic for different reasons and it’s not from a chemical imbalance. Mine was from trauma and i had no idea. They even came out with the study that shows depression is not a chemical
Imbalance. I truly think it all goes back to trauma. You don’t have a chemical imbalance. Something triggered your panic and the drug suppressed it. I promise you I thought the same exact things you are saying. Now i am 34 and i went from a full functioning happy person to now being bedridden. I am more than happy to talk to you one on one. All the things you are saying are the same things I said. I just don’t want anyone to have to go though what I am
Or what others are.
Whatever it does is amazing. I’ve been anxious all my life at 35 became home bound. Set in a chair never leaving my house for 15 years with crippling anxiety. Tried everything known yo man. Med wise and unconventional remedies. Diet change. Exercise. Nothing worked. At 50 I said either die or get on the horrific benzodiazepines. Boy was I bamboozled by the stigma. They saved my life. I went from being terrified to leave a particular room to getting my masters in social work. Keep your horror stories to yourself and realize we are all different and need different things.
Also I want you to know, i was put on this because my panic was caused my severe cptsd -i had many traumas that led to this. And yes i had a quality of life for 14 years but this drug doesn’t allow you to move forward instead of living in past trauma. What it does is suppress that trauma and sedates it so it doesn’t bother you. Problem is our body’s remember these traumas and eventually that trauma will come out in other ways. Like i said in another post, this drug gave me what i thought was my life back…14 years later my panic started to return severely and that was from the drug now becoming a dependence thing. I know there are some people who get lucky and never have this issue but that’s like playing Russian Roulette. It’s not ok for doctors to keep prescribing this and then people like myself and others start to suffer immensely. I never thought what happened to me could happen. Now i have educated myself and know that I need to process my trauma in a safe way once I am off this drug. I didn’t think my trauma was even effecting me after being put on klonopin. But eventually it backfired and I know now that suppressed it all so it didn’t bother me. But do you think it’s worth it to let doctors keep prescribing this to patients now knowing that many will eventually suffer something that could have been prevented. This isn’t a game. One too many people have had their lives ruined from this.
That’s not true for all. I have no trauma except what was caused by agoraphobia. Talk with a therapist and on benzodiazepines. Life started for me the day I took the first one. Glorious to know what normal felt like. Also got my masters in social work. A year before that I was afraid to take a bath. Literally afraid to bathe.
I’m not being smart. Try getting off of it after using it that long, and see if your opinion stays the same.
The benzo puts gaba in your brain and body. The brain, which naturally manufactures gaba on its own, doesn’t have to do that now, and the gaba receptors in your brain go dormant. Quitting the benzo at that point leaves many, if not most, people in a state of mental and physical agony that simply cannot be adequately described. People can die quitting cold turkey.
Others, having quit, can have horrible physical and mental symptoms continue for years, or never go away at all.
You are correct on all accounts. Even a well known physician who doesn’t prescribe benzodiazepines does brain scans and says our brains are different. They are definitely different and I tried all the other meds ans did ALL the things before benzodiazepines. Nothing worked.
Dear Editors,
Thank you for this site. It is rare to find an agency or organization that is willing and brave enough to speak an uncommon truth about benzos. It should be in violation of the Nuremberg Code and grossly negligent for a medical professional at any level and of any discipline to not fully inform a potential client of the life threatening side effects and the known traumatic experiences suffered with attempts to withdraw. These drugs are useless illusionary crituches for those who believe they do not have the personal power to correct their imbalances, and all benzos should be outlawed with those who continue to prescribe being punished according to the law (Nuremberg Code). Those prescribing for children should be arrested and charged with chemical child abuse, a law that is yet to be written and considered for deliberation.
I was 16 or 17 when i was started on these. Now 34 and have been bedbound for 4 years