Remarks y Benzodiazepines for panic disorder examined in the included reviews were alprazolam, adinazolam, clonazepam, diazepam and midazolam. y Benzodiazepines for GAD examined in the included reviews were not reported individually. y Benzodiazepines have a risk of dependence. Use beyond the recommended 3- to 7-day maximum period requires monitoring and follow-up by trained specialist providers and is beyond the scope of this guideline.

Implementation considerations y Benzodiazepines should not be universally prescribed to treat anxiety or distress and should instead be used in select cases of acute and severe anxiety or distress and where other treatment approaches have proved ineffective or unavailable. y Before prescribing benzodiazepines, discuss the treatment options and any concerns the person has. Explain the rationale for prescribing this medicine and provide written and verbal information on benefits and harms; side-effects; drug interactions; the importance of taking medicines as prescribed; risks when driving, operating machinery, etc.; the likely time to improvement in symptoms; and the potential for addiction. y Discontinue benzodiazepines gradually as soon as symptoms improve to avoid tolerance. y For adults who demonstrate potential signs of dependance, consider management approaches for benzodiazepine withdrawal and dependance; for further information, see the 2015 Update of the Mental Health Gap Action Programme (mhGAP) guidelines for mental, neurological and substance use disorders (7) and the 2016 mhGAP intervention guide module on “Disorders due to substance use” (9).