Coaching: Anxiety Disorder: We all have anxiety, not only is it normal it is essential for survival, in fact as a caveman the more anxiety you had the more likely you were to escape predators and achieve survival needs. The irony is that in todays society it these people that suffer the most as just like the rest of us they are hard wired to continue escaping illusionary predators and acquire illusionary survival needs that marketing and social media imprison us with. We discussed stress last week which is mostly a normal response for an individual to a situation where they do not feel in control However if severity of anxiety or duration exceeds what is reasonable then it may become a clinical disorder. Anxiety Disorder: 33% life time prevalence of anxiety disorder often co morbid with depression or other anxiety disorders, and 4% life time prevalence of GAD higher and more impairing in high income countries. Females twice as likely as males. Generalised Anxiety Disorder: DSM V 300.02 Generalised Anxiety Disorder: 8 studies of biological interventions: Current Psychiatry July 2022 Saeed Majarwitz Generalised Anxiety Disorder usually starts in early adulthood and persists throughout life. Anxiety about a variety of events is excessive and unreasonable and causes distress and impairs functioning. There is a big variability in the effectiveness of physical intervention for Generalised Anxiety Disorder. SSRI, SNRI, agomelatine (melatonin 1 and 2 R agonist and 5HT 2c R antagonist – antagonism increases noradrenaline and dopamine)- as effective as SSRI maybe with fewer side effects eg nausea and sexual side effects. Less used: Buspirone - 5HT 1a R agonist. Acute anxiety: Benzodiazepine. rTMS (FDA approval for Clinical depression 2008) right parietal cortex or right dorsolateral prefrontal cortex with reduced relapse after completion of treatment. CBT alone and improves response to medication. Plus: Diet exercise reduce alcohol and cigarettes, structure , self awareness , sleep with positive studies for magnesium, chamomile extract and antioxidants. Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe Ayelet Meron Ruscio, PhD1 ; Lauren S. Hallion, PhD2 ; Carmen C. W. Lim, MSc3 ; et al Dialogues Clin Neurosci. 2015 Sep; 17(3): 327–335. Epidemiology of anxiety disorders in the 21st century Borwin Bandelow, MD, PhD* Ann Behav Med. Author manuscript; available in PMC 2016 Aug 1. Generalised Anxiety Disorder: 8 studies of biological interventions: Current Psychiatry July 2022 Saeed Majarwitz Published in final edited form as: Ann Behav Med. 2015 Aug; 49(4): 542–556 Exercise as Treatment for Anxiety: Systematic Review and Analysis