Placebo Effect

A 50-something year old woman came into the clinic last week.  This would be her third visit since I have been here.  On her first visit, her complaint was difficulty breathing, a racing heart rate, chest tightness, and an overall sense of anxiety.  After ruling out any of the life threatening stuff, it was pretty clear she had general anxiety disorder.  We decided to put her on a beta-blocker - propranolol - which, in the US, has an off-label usage for treatment of anxiety attacks.  It turned out to work pretty well for her so she came in a second time and we sent her off with the same medication.  So by now, this was her third visit, she was in the middle of a panic attack, and we needed to try something else because we couldn't just put her on beta-blockers forever.  Benzodiazepenes (sleeping pills) wouldn't have been a great idea either with the added problem of addiction risk.  A psychiatrist is what she really needed, but I figured my chances of finding a cup of Stumptown coffee here would be better (I would kill for one...no, really I would).  But I had an idea.  Now, I should explain, normally I do not like to deceive patients, but I didn't feel like we had another choice under the circumstances.  We gave her a children's multi-vitamin and told her it was really strong medication.  After she chewed on it, we chatted with her for a little while to find out what else was going on her life.  Finally, we decided to give her a couple of bags of antacids and adult multivitamins.  While handing it over to her, speaking in Khmer, she said something to Thea, who started to laugh.  She turned to me and said, "She said that the other drug works very well and she feels much better now."  I quickly swallowed my laugh before we gave away our little secret.  So we gave her another bag of the children's multi-vitamins that we split into many pieces to make them last her a little longer.  She seemed pretty happy with her new treatment.  It's not going to fix her life, but if a little bit of grape flavored pill makes her feel better for an hour or two, I suppose that's something.