Brief Answer: Relaxation exercises. Detailed Answer: Hi XXXXXXX Welcome to Healthcare Magic! You have lived a hard life with so much of stress and you have been right in trying methods like meditation for helping you. However, meditation is not easy for people who have anxiety and even for others as they often tend to lose concentration. In my opinion, you can continue practicing meditation but also try other methods of relaxation like relaxation exercises that have been tried and tested in people with anxiety and found to be effective. A simple but very effective method is that of taking slow and deep breaths whenever you feel that you are anxious or going to have a panic attack. Within a couple of minutes, you will notice a reduction in your heart rate that usually shoots up in anxiety and will start feeling calm. You can do this for a few minutes many times a day. For more complete relaxation, progressive muscular relaxation exercise is a very effective method. In this relaxation technique, you focus on slowly tensing and then relaxing each muscle group. This helps you focus on the difference between muscle tension and relaxation. One method of progressive muscle relaxation is to start by tensing and relaxing the muscles in your toes and progressively working your way up to your neck and head. You can also start with your head and neck and work down to your toes. Tense your muscles for at least five seconds and then relax for 30 seconds, and repeat. You can find more detailed instructions online at many sites. I have included one such link for you ( WWW.WWWW.WW au/docs/ACF3C8D.pdf). You can take a print-out and practice it. Autogenic relaxation is another method. Autogenic means something that comes from within you. In this relaxation technique, you use both visual imagery and body awareness to reduce stress. You repeat words or suggestions in your mind to relax and reduce muscle tension. For example, you may imagine a peaceful setting and then focus on controlled, relaxing breathing, slowing your heart rate, or feeling different physical sensations, such as relaxing each arm or leg one by one. Visualization is another method. In this relaxation technique, you form mental images to take a visual journey to a peaceful, calming place or situation. During visualization, try to use as many senses as you can, including smell, sight, sound and touch. If you imagine relaxing at the ocean, for instance, think about such things as the smell of salt water, the sound of crashing waves and the warmth of the sun on your body. You may want to close your eyes, sit in a quiet spot and loosen any tight clothing. Choose whatever method you like and practice it. You will notice greater benefit as you become adept in it. Regarding medicines, perhaps Valium suits you more as it is longer acting. Xanax and Ativan are short acting and associated with rebound anxiety when the drug level in the body falls. Effexor should work well but in my experience, I have preferred SSRIs like Paxil for severe anxiety and panic, especially in people with heart disease. Hope this helps you. Please feel free to ask if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry

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