online conference transcript
Carol Watkins is a board certified psychiatrist. She has written numerous articles on the treatment of anxiety disorders in children and adults, and maintains a website on anxiety issues.
David Roberts: HealthyPlace.com moderator.
The people in blue are audience members.
David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Anxiety and OCD Medications." Our guest is psychiatrist, Carol Watkins, who is board certified in adult and child psychiatry. She is a clinical assistant professor of psychiatry at the University of Maryland and maintains a private practice in Baltimore, Maryland. She is the author of many published psychiatric papers and a frequent lecturer at workshops and seminars. Dr. Watkins has also written numerous articles on the treatment of anxiety disorders in children and adults, and maintains an active online resource site dealing with anxiety, that you can locate here.
If you are looking for information on a particular medication, you might want to try the HealthyPlace.com psychiatric medications area.
Good evening, Dr. Watkins and welcome to HealthyPlace.com. We appreciate you being our guest tonight. We get a lot of email that goes something like this: "I've tried 3-5 different medications for my anxiety or OCD and nothing seems to work." Why is it that psychiatric medications work for some but not for others?
Dr. Watkins: Each person is different, both in personality and in their individual biochemistry. Some people have different rates of metabolism based on differences in their liver metabolism. On the personality side, people have different attitudes and expectations of medication.
David: What is a reasonable expectation when it comes to the performance of a anti-anxiety medication?
Dr. Watkins: A certain percentage of individuals of each ethnic group may have different enzymes that metabolize a particular medication. It depends on the subtype of anxiety. For OCD, you might expect a 50-70% positive response with medication. Higher, if combined with the appropriate psychotherapy.
David: And for an anxiety disorder or panic attacks, what can one expect?
Dr. Watkins: For panic attacks, I would expect a similar response rate. I often start with smaller medication doses for panic than for Obsessive-Compulsive Disorder. For generalized anxiety, I expect a lower medication response and emphasize therapy in addition to the medication.
David: If you are suffering from an anxiety disorder, would you recommend medications as a first line of treatment, or would you say to the patient, try therapy first and if that doesn't work, then we'll talk about anti-anxiety medications?
Dr. Watkins: It depends on the situation. For adults, I discuss both options. If the symptoms are mild, I am more likely to go with therapy first. If severe, I often recommend starting with medication and therapy simultaneously. For children, I am more likely to recommend a course of therapy first. However, in some cases, if the anxiety symptoms are pervasive, or if the child refuses therapy, I might start medication right away.
David: I know you are a psychiatrist, but I'm wondering what your thoughts are about a person going to see their family doctor and having that doctor dispense medications for their anxiety disorder versus seeing a psychiatrist to be treated?
Dr. Watkins: In some cases, there are primary care physicians who know the patient well, maybe for decades. The physician might know and treat the family too. If the doctor has the time and expertise, then it is OK. If the doctor is busy and can only allot a few minutes, it is better to refer. If the person does not respond well to the first treatment, then a referral is also a good idea. I deal with some primary care physicians who know me and have a good sense of when to refer on to a psychiatrist.
David: We have a lot of questions, Dr. Watkins, and then we'll continue with our conversation.
Sharon1: How do you feel about Serzone as a treatment for panic disorder?
Dr. Watkins: I prefer to start with a SSRI, such as Zoloft (Sertraline) or Luvox (Fluvoxamine) and reserve Serzone if the person has side effects on a SSRI.
sadsurfer: What do you think of alternative medicine, such as acupuncture or massage therapy alone to reduce anxiety if one wishes to come off medication?
Dr. Watkins: Some people get good results with acupuncture. One should also realize that many people get good results with cognitive behavioral therapy or hypnosis without using medications at all.
David: So are you saying that hypnosis and acupuncture are legitimate treatments for anxiety disorders?
Dr. Watkins: I believe that hypnosis, cognitive behavioral therapy and some other forms of therapy are legitimate. I am not an acupuncturist, but I have seen some good results. I do get concerned when some acupuncturists go on to prescribe herbal preparations without checking with me to make sure that they are not interacting with my medications. This can be dangerous.