DiscussionBiomedical Sciences: Generalized Anxiety DisorderDC was diagnosed with generalized anxiety disorder (GAD), a common anxiety disorder, with an estimated lifetime prevalence of 5% (using DSM-IV criteria)[1]. It is characterized by persistent, uncontrollable anxiety and worry that the patient generally recognizes as excessive and irrational. It can be a chronic and debilitating disease and worsen the prognosis of other diseases[2]. The exact mechanism of GAD is unclear. Given the high degree of comorbidity of GAD and depression, and the fact that the symptoms of both conditions respond to the same treatment, it is possible that the two conditions share a common neurobiological dysfunction[3]. The involvement of the serotonergic (5-HT) system is perhaps the most studied mechanism. Serotonergic pathways between the dorsal raphe nucleus and the temporal lobe, hippocampus, and amygdala are thought to play key roles in the regulation of anxiety and in the management of chronic adversity and depression. In patients with GAD, 5-HT levels in the cerebrospinal fluid are reduced compared to control patients, a finding replicated in suicidal individuals. Depletion of 5-HT in the brain during 5-HT depletion studies using tryptophan has been shown to cause relapse in depressed patients on selective serotonin reuptake inhibitors (SSRIs), thus confirming the role of 5-HT in depression. Until now, there have been no similar studies for GAD[3]. Neuroimaging results indicate that overactive brain circuits occur in GAD. It has been hypothesized that hyperactivity in specific areas gives rise to the symptoms of GAD (e.g., hyperactivity in the basal ganglia and temporal lobes results in motor strain and autonomic changes, respectively).[3] ...... middle of article. .....particularly important points to address[7]. In the case of DC, he has a number of epidemiological and clinical risk factors and, in this sense, he is at high risk of complete suicide within the next year. The Pierce (7/25) and Beck (25/45) scales indicate average suicidal intention. There are, however, some reassuring elements in the story: the act was impulsive; DC sought help immediately after the act; and he did not take the extra venlafaxine tablets available in his apartment. His interview and mental status examination were also encouraging. Several steps could be taken to reduce one's risk of suicide, from the immediate (e.g. removing extra venlafaxine tablets from one's apartment) to the longer term (e.g. finding a job). Adequate social support should be in place before he returns home, through a combination of IHTT, his father and his CPN and OT..