Katrina Chen is a 23 year old with a history of severe anxiety and hospitalization after particularly acute panic attacks. She has tried a variety of psychotropic medications and of these she believes that Prozac is the best at managing her symptoms. She is concerned, however, with its addictive nature and doesn’t like taking “chemicals”.
She has recently started working with a naturopathic doctor (ND) with the goal of getting off Prozac. Her naturopath has compounded a herbal remedy to treat her anxiety, explaining that it contains primarily valerian as the active ingredient, and she has also begun biofeedback treatments. Katrina feels that the valerian has been effective in reducing the severity of her symptoms and was planning on reducing her dosage of Prozac.
Katrina has been hospitalized again after a panic attack and is requesting that the hospital provide her with the valerian in addition to her Prozac prescription. She has no family in the area and a minimal social network such that she has no other way to obtain valerian. The fact that she does not have access to valerian seems to be increasing her agitation and anxiety.
The health care team is concerned about several aspects of this case. They’ve come to you with the following questions:
- Is the hospital obligated to provide alternative therapies in response to such requests by patients?
- Is the team obligated to provide valerian with Prozac given a potential risk of adverse interactions between the two compounds?
- If there seems to be very little good evidence that valerian is effective as a treatment for anxiety, should the team actively discourage Katrina from taking it?
