Local psychiatrist combats mood disorders and depression in patients diagnosed by others as ‘treatment resistant’
When Philip Botkiss was a child, he suffered from allergies and often got sick.
His parents had lost one 18-month-old child before Botkiss was born and were in constant fear of losing another child.
“So, you can imagine,” Botkiss said, “every time I got sick, I was right to the doctor because my parents … really never got over that loss.”
He and his parents became frequent visitors to the local pediatrician up the street in their Maryland suburb of Washington, D.C.
“He was always a source of comfort for me and my family,” Botkiss recalled. “He was always very calm, always knew what was going on and would always reassure my parents… As a result, I had a positive introduction to what medicine was about.”
He came to regard his pediatrician as a role model and wanted to be like him. He wanted to help and comfort people.
And that’s exactly what he has been doing, not as a pediatrician or the cancer researcher that he had once considered becoming, but as an “in the trenches” psychiatrist, working both with children and adults, here in San Diego for the past 20 years.
Name: Philip Botkiss, M.D.
Distinction: Dr. Botkiss is a clinical psychiatrist at Sharp Mesa Vista Hospital. He specializes in mood disorders and depression. He also recently opened a private practice in the Del Mar Heights area offering TMS, a new FDA-approved treatment for depression.
Resident of: Rancho Santa Fe since 1997
Born: Washington, D.C.
Education: B.S. degree in biology, Rice University, Houston, Texas, 1981; M.D., University of Texas Medical School of Houston, 1985; internship in psychiatry and neurology, University of Texas Health Science Center, Dallas; completed residency in psychiatry, University of California San Diego, 1989. Board certified clinical psychiatrist.
Family: He and his wife, Kathleen (nee Smith) have been married 14 years (1996). They have three children: daughter, Shea, 13; and sons, Beau, 11, and Miles, 7.
Interests: Working out regularly and attending his children’s sporting events.
Recent Reading: The Immortal Life of Henrietta Lacks, by Robert Skloot.
Philosophy: “Persistence pays off.”
We interviewed the 50-year-old Rancho Santa Fe resident and father of three in the day-treatment area of Sharp Mesa Vista Hospital, the largest free-standing psychiatric facility in San Diego, where Botkiss is a clinical psychiatrist, treating mostly adults, and clinical director of a day treatment program for adolescents, 12 through 17.
“I’m treating patients who are what is called ‘treatment resistant,’ who have failed medications and other therapies so they come here to the hospital because they are still very sick and need more help,” he said.
In addition, Botkiss runs his private practice on High Bluff Drive in the Del Mar Heights area.
Botkiss is tall, slender and photogenic, which helps because he frequently appears on TV as a local expert on psychiatry, called upon to comment on issues ranging from the treatment of registered sex offenders and tragedies such as school shootings to Tiger Woods, veterans suffering from post-traumatic stress and the latest advances in psychiatry.
Born in Washington, D.C., Botkiss grew up in nearby Kensington, Maryland. His father was the owner of a business representing various hotels for functions, meetings and conventions.
After graduating from Rice University, Houston, Texas, with a degree in biology in 1981, Botkiss went on to earn his medical degree from the University of Texas Medical School of Houston in 1985. Following an internship in psychiatry and neurology at the University of Texas Health Science Center, Dallas, he completed residency in psychiatry at the University of California San Diego in1989 and is a board certified clinical psychiatrist.
He specializes in the treatment of mood disorders, such as depression and bipolar disorder, using medications and brain stimulation technologies, specifically electroconvulsive therapy (ECT), which is still used in modern psychiatry to treat severe and life-threatening depression.
“Our facility probably does the most ECT of any facility in California,” he said. “To most lay people of our generation, they think of ECT as being like that administered in [the 1975 film] ‘One Flew Over the Cuckoo’s Nest.’ The reality is that modern day ECT is administered in a much different manner. Patients are under anesthesia so there’s no pain, no discomfort.”
The downside to ECT, he said, is that patients often experience temporary short-term memory loss.
“And that can be, as expected, particularly troublesome, depending on the degree. The good news is that over time that should clear, but it could take a period of weeks to months, and in the meantime that can affect a person’s ability to function from a cognitive standpoint.”
Patients undergoing ECT sessions are restricted from driving.
Recently, Botkiss became the first private practitioner in San Diego to offer patients another therapeutic option for clinical depression called Transcranial Magnetic Stimulation (TMS), a non-invasive treatment, approved 18 months ago by the FDA, that sends magnetic pulses into the mood-regulating part of the brain.
TMS is painless, requires no anesthetic, can be done in a doctor’s office, causes no memory loss and has no driving restrictions.
However, he said, “at this point TMS has not been shown to be as effective at ECT ... for severe and life-threatening depression. So there are certain patients where you want to try ECT first.”
Because TMS is a new procedure, it is not yet covered under government insured services and by only limited private insurance.
It is available through the prescription of a psychiatrist at the Botkiss Center for TMS Therapy San Diego (12625 High Bluff Dr., #312, San Diego, (619) 291-7100).
Asked how he personally copes every day working with patients who are are in various stages of depression, he said, “My way of approaching this is I’m here to help. And the best way I can help is to be able to make a diagnosis and based on that to develop a treatment plan for my patient. So I’m not focusing as much on the content that someone may share with me, as much as on the process [to help]. And that’s very gratifying.
“Of course,” he said, “for a psychiatrist the most negative outcome is [when a patient commits] suicide. I think any psychiatrist who works with enough patients will have some suicides in their career and I have as well. I think you have to approach patient care with the understanding that that will sometimes happen, no matter what you do, despite your best efforts …
“But what I try to do, is not only assess the level of suicide ideation, but to also instill some hope and optimism when I meet with patients. And I think I have a good style in doing that because I am upbeat, I like to emphasize the positives …So I’ve learned in my career, always offer your patients something, never say, there’s nothing else we can do…”
He often has patients referred to him by outside therapists or other doctors because they are not responding to treatment.
“I feel the bucket stops with me, so I have to give them something different. I have some tools that I can use to give them that difference, whether it’s more medications, or different combinations, whether it’s ECT and now TMS. So that fits with my practice, being able to offer a spectrum of care.”
His major interest outside of work, he revealed, is attending his children’s sporting activities.
“Again, going back to my childhood, because my parents were so concerned about me getting hurt, I really wasn’t allowed to participate in organized [team] activities…
“So my kids have the advantage of that. I love attending their sporting events. It’s a delight for me to go out there. My wife would say I’m living vicariously, but I love it. I love to go there. I love to watch their enthusiasm.”
By Arthur Lightbourn
Profile Philip Botkiss, M.D.