WHO provides new and updated recommendations for the treatment of mental, neurological and drug use conditions

The World Health Organization (WHO) today published the third edition of the Mental Health Gap Action Plan (mhGAP) guidelines, which include important new and updated recommendations for the treatment and care of mental, neurological and substance use (MNS) disorders.

MNS disorders are major contributors to morbidity and premature mortality in all regions of the world. However, it is estimated that more than 75% of people with MNS disorders are unable to access the treatment or care they need.

The mhGAP guideline supports countries to strengthen capacity to address the growing burden of these conditions. It is intended for physicians, nurses, other health care professionals who work in non-specialized settings at the primary health care level, as well as for health planners and managers.

“For 15 years, mhGAP has played a vital role in improving access to evidence-based psychological interventions and medicines for the treatment and care of people with mental, neurological and substance use disorders. Given the increasing relevance of mental health, this evidence-based guideline is more important than ever to support primary care providers to treat people with MNS disorders,” said Devorah Kestel, WHO Director of Mental Health and Substance Use.

The 2023 guideline update includes 30 updated and 18 new recommendations related to MNS conditions, along with 90 previously existing recommendations.

New recommendations for anxiety disorders

The guide contains a new module on anxiety, which reflects the growing number of people with anxiety disorders, one of the most common mental disorders in the world. The module includes the following recommendations:

• Psychological interventions based on cognitive behavioral therapy (CBT) should be offered to adults with generalized anxiety disorder and/or panic disorder. These interventions can be offered in a variety of formats, including online, in-person, group, or self-directed.
• Stress management techniques should be considered for adults with generalized anxiety disorder and/or panic disorder.
• Selective serotonin reuptake inhibitors (SSRIs) should be considered for the treatment of adults with generalized anxiety disorder and/or panic disorder.

Psychological and psychosocial interventions

The guideline outlines the continued importance of psychological treatment for a range of MNS conditions.

The MhGAP guideline contains new recommendations for psychosocial interventions for people with psychiatric or bipolar disorder, as well as new recommendations for psychosocial interventions for children and adolescents with psychosis, alcohol dependence, substance use, dementia, and neurodevelopmental disorders, including autism, ADHD, and neurodevelopmental disorders. : stroke

Women and girls who want to become pregnant or may become pregnant should not use valproic acid (sodium valproate).

The guideline contains an updated recommendation recommending against the use of valproic acid (sodium valproate), a drug used to treat epilepsy and bipolar disorder, because of the risk of birth defects when taken during pregnancy.

The guidelines recommend the following:

• Valproic acid (sodium valproate) should no is prescribed to women and girls who want to become pregnant or who may become pregnant because of the increased risk of birth defects and developmental disorders in children exposed to valproic acid in the womb.
• Women and girls currently prescribed valproic acid (sodium valproate) should be counseled on the use of effective contraception.
• It is important that women and girls do not stop taking valproic acid (sodium valproate) without first discussing it with their doctor.
• Women should be advised to consult their doctor immediately after planning pregnancy and to consult their doctor immediately if pregnant. Every effort should be made to switch to appropriate alternative treatment before conception.
• A specialist should regularly review whether valproic acid (sodium valproate) is the most appropriate treatment for the individual.

The guideline reflects the May 2023 WHO safety statement on the use of valproic acid (sodium valproate) for the treatment of epilepsy and bipolar disorder in women and girls of reproductive potential. This was discussed at the meeting of the Advisory Committee on the Safety of Medicines (ACSoMP) of the WHO. [2022 December ACSoMP recommendations]. A safety statement has also been added to the Essential Medicines List (EML).

Other recommendations:

• Digitally delivered psychological and psychosocial interventions work across multiple modules: alcohol use disorders, anxiety, stress-related conditions, substance use disorders and self-harm and suicide.
• Updated recommendations for non-pharmacological interventions to improve outcomes for people with dementia, including exercise, CBT, cognitive stimulation therapy and cognitive training.
• Treatments for psychosis and bipolar disorder include quetiapine, aripiprazole, olanzapine, paliperidone, and the long-acting antipsychotics haloperidol and zucopentixole. Levetiracetam and lamotrigine are included in the treatment of epilepsy.

Notes to editors:

• First published in 2010 and last updated in 2015, the mhGAP guideline and related products, including the mhGAP intervention guideline, are now used in more than 100 countries and are available in more than 20 languages.
• The mhGAP guideline has been updated in line with the WHO guideline development manual and meets international standards for evidence-based guidelines. In collaboration with the Guideline Development Group (GDG), Thematic Expert Groups (TEGs) and the guideline methodologist, the WHO steering group identified priority questions and outcomes to determine which are important for updating the mhGAP guideline. Systematic reviews of the evidence were used to develop the Evidence to Decision and Summary of Findings tables according to the Grading of Recommendations, Development and Evaluation (GRADE) approach. The GDG developed recommendations that took into account a number of elements, in particular the reliability of the evidence; the balance between desirable and undesirable consequences; the values ​​and preferences of the intended users of the intervention; resource requirements and cost-effectiveness; health equity, equality and non-discrimination; feasibility; human rights and socio-cultural acceptability.