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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by harry_in_philly on January 9, 2007, at 17:57:21
anyone in philly, nj, de, md know of a good MD that will prescribe meprobamate (miltown). I want it because benzos aren't working to help my generalized anxiety disorder/insomnia. Anyone also know of an MD that would prescribe either a barbiturate or chloral hydrate to treat insomnia?
Thanks,
Harry
Posted by med_empowered on January 9, 2007, at 21:25:48
In reply to miltown/equanil/meprobamate, posted by harry_in_philly on January 9, 2007, at 17:57:21
I dont know of any docs specifically, but I've read that since NY and some other states have started requiring triplicates for benzos (but apparently not most other schedule III-V meds), Miltown and chloral hydrate have suddenly made a comeback in those places, mostly because docs don't want to deal with DEA or the triplicate system.
As for barbs...just from what I've read, some docs will do 1-2 weeks with seconal or nembutal, but longer than that I imagine you'd need to have a long history of demonstrated non-response to safer meds along with a pretty good psych. history (no suicide attempts, overdoses, recent drug abuse, that sort of thing). That said, I imagine in the same states where chloral hydrate+miltown are coming back certain barbiturates (phenobarbital, maybe aprobarbital) would also be popular, since they're schedule III-IV.
Posted by Quintal on January 9, 2007, at 21:51:30
In reply to miltown/equanil/meprobamate, posted by harry_in_philly on January 9, 2007, at 17:57:21
Well I'm not sure barbs or meprobamate are really appropriate for those conditions. I've taken barbs and they weren't what I hoped they would be. They seemed to sap all the color and enjoyment out of life similar to antipsychotics and the mental deadening effects were horrible. Have you tried MAOIs? Nardil particularly as it has a GABAergic metabolite that seems to have a barbiturate-like effect. Nardil can augment the effects of benzos for this reason. That may be a more acceptable option to the pdoc if he is unwilling to prescribe those other drugs you mentioned?
Q
Posted by yxibow on January 10, 2007, at 3:08:51
In reply to miltown/equanil/meprobamate, posted by harry_in_philly on January 9, 2007, at 17:57:21
> anyone in philly, nj, de, md know of a good MD that will prescribe meprobamate (miltown). I want it because benzos aren't working to help my generalized anxiety disorder/insomnia. Anyone also know of an MD that would prescribe either a barbiturate or chloral hydrate to treat insomnia?
> Thanks,
> HarryI'm not really sure you want to go down the meprobamate road -- it is an old drug, also C-IV, and while the action isn't quite known it does affect GABA-A just like benzodiazepines. I assume you've been through every anxiolytic benzodiazepine available at strengths up to 4 or 8mg of Klonopin. While it is a carbamate, it basically has barbiturate toxicity. And using a barbiturate today also as you were inquiring, is sort of out of the realm of general practice except for hospital settings. The window between effectiveness and respiratory depression (that's an emergency room term, not something you can regulate on your own) of either a barbiturate of any kind or Miltown is slim. Additionally, Miltown can develop dependence more than it was originally thought to be. Similar to its metabolic and non-scheduled cousin Soma, which I must admit is quite a back relaxant but can build up tolerance if not kept in check.
Its something that you would have to have a doctor with definite experience in, which sounds like you are searching considering you are willing to drive congested east coast highways to 4 states. (And the stares you would get in pharmacies about Miltown in the different states you would have to be prepared for as it hasn't been in common use since 1955.)
Being an insomniac myself, have you considered or tried Ambien at 20mg, or Lunesta at 4 (I've tried that) or god forbid 5mg, or Rozerem. Or any of the above plus/and/or a say, 25mg dose of Seroquel? Any of those, in combination even, would be far less lethal than barbiturates or chloral hydrate which is basically yucky alcohol.
I don't normally believe in the use of antidepressants/neuroleptics for their side effects but 3.75 or 7.5mg of Remeron or 25mg of Seroquel would be far safer choices.-- tidings
Posted by ed_uk on January 10, 2007, at 14:17:23
In reply to miltown/equanil/meprobamate, posted by harry_in_philly on January 9, 2007, at 17:57:21
Hi Harry
Meprobamate isn't generally very effective for anxiety. Some studies showed it to be no more effective than a placebo. It certainly causes drowsiness but this doesn't make it an effective anxiolytic. What makes you want to try meprobamate?
Ed
Posted by harry_in_philly on January 10, 2007, at 18:18:27
In reply to Re: miltown/equanil/meprobamate » harry_in_philly, posted by yxibow on January 10, 2007, at 3:08:51
For insomnia I've tried Restoril, Ambien, Sonata, Lunesta and Vistaril. Actually 150mg (3 capsules)worked the best but I quickly developed tolerance. Ambien was by far the worse--didn't help at all. Sonata and Lunesta were about equally effective. Generally I'd be able to sleep within 1-2 hours after taking it but would be up again in another hour. Occasionally I'll take four or five Donnatals (prescribed for my Crohns' Disease) but am afraid to take too much because I'm not sure of the potential risks of Belladonna toxicity.
I've taken Soma before and it works great for muscle relaxation. I've also taken Remeron and Trazadone before for depression. Remeron was horrible--gained nearly 50 pounds. Trazadone made me feel like a zombie the next day. I've never taken anything that left me with a worse hangover than the 150mg of trazadone that was prescribed---worse than downing half a bottle of cheap tequila!
Posted by harry_in_philly on January 10, 2007, at 18:21:07
In reply to Re: miltown/equanil/meprobamate » harry_in_philly, posted by ed_uk on January 10, 2007, at 14:17:23
In all honesty, my family has a history of depression and anxiety. My Grandmother, now nearly 90, was diagnosed with "neurosis" back in the 50s. She's been taking Miltown since then and swears by it. She hasn't developed tolerance and still takes only 400mg I think three times daily, maybe two. She also takes seconal for insomnia -- but has complained to me that she can't get tuinal anymore (which she preferred over seconal). By the way, her doctor is 88 and is not accepting new patients. Perhaps that is why she has never been prescribed newer meds--but why experiment with new meds when the old ones are working just fine?
Posted by yxibow on January 11, 2007, at 1:46:05
In reply to Re: miltown/equanil/meprobamate, posted by harry_in_philly on January 10, 2007, at 18:21:07
> In all honesty, my family has a history of depression and anxiety. My Grandmother, now nearly 90, was diagnosed with "neurosis" back in the 50s. She's been taking Miltown since then and swears by it. She hasn't developed tolerance and still takes only 400mg I think three times daily, maybe two. She also takes seconal for insomnia -- but has complained to me that she can't get tuinal anymore (which she preferred over seconal). By the way, her doctor is 88 and is not accepting new patients. Perhaps that is why she has never been prescribed newer meds--but why experiment with new meds when the old ones are working just fine?
I can't comment on your doctor and family patient who are both of high age, but seconal and Miltown, together, are DANGEROUS for someone at that age, when liver and other drug elimination functions are not at their prime. Not making any assumptions on whether either of the two are not compos mentis, but I know that my grandmother in her 80s had serious problems with handling even doxepin, but that was partially her doctor misguiding on the safety of it. Falls can happen.
Anyhow as far as yourself, although I question a quad state search for doctors for C-IV ancient medications -- remember, you will be a new patient and "shopping" for medication is quite easily detected. Doctors do not like to risk their DEA license on controlled substances, especially ones that are not de rigeur.
And as for ancient medications -- remember benzodiazepines, which apparently you do not respond to any of them (they've been around almost as long as Miltown), which I suppose is possible but you do realize that Miltown does affect GABA-A as well in a different way I guess. Its exact method is unknown really because sophisticated testing like P450 interactions and all weren't around. Its cousin Soma is also somewhat more euphoric than benzodiazepines, prompting some caution of habituation.
I'm sorry to hear that you have concommitant Chrons' Disease -- that can make medication choices an issue as well. Donnatal -- if it works, that is great, but aren't there newer medications? As for belladonna toxicity -- I can tell you what mild atropine toxicity feels like. Anticholinergics have atropine relations and I do take Akineton or Artane at times for movement and other esoteric side effect issues. They can creep up upon you, especially on an empty stomach. You may not feel anything at the time and feel the need to take another, and you've silently exceeded a comfort zone. Hours later or the next day you can feel cold or hot, and rather loopy. So yes, do heed caution with anything that affects the cholinergic system, primitive parts of the body.
Trazodone is a rather yucky drug in my opinion besides the greater than listed chance of priapism in males -- I don't particularly recommend it unless someone really happens to like it. It also can develop a semi-tolerance to the sedation and one has to start at a low dose again. And forget the cheap tequila, you'll black out with this drug.
Donnatal and Vistaril, by the way, are combinations of anticholinergic agents and should be monitored carefully by your doctor or the toxicity mentioned above can develop.
Atarax if we're on the discussion of old agents, and you actually could stand it (its a bit drying I believe), I wouldn't be that surprised actually because it also can serve at least a small functionality for your GAD. It is both an anxiolytic, an antihistamine, and I suppose prescribed for sleep as well. The tolerance you developed sounds much like the "tolerance" towards Trazodone actually, you have to back off and start again because you're really taking it for its sedative effect which one can become used to in a drug primarily first developed for an antihistamine.
Curious that Ambien was the worst as it is the most potent generally -- did you try it at 20 ? It though, not mentioned, is still safe at that point.I assume you have tried Melatonin and its much more powerful prescription Rozerem.
Have you had a sleep study done ? I'm wondering whether the quality of sleep and shortness has anything to do with possible sleep apnea. Also, I would imagine that incompletely controlled Chrons' disorder would probably also interrupt sleep.
Also, do you go to bed at the same time most every night and use the bedroom only for sleeping, do some exercise around 2-4 hours before sleep and don't engage in brain intensive activites just before sleep such as computer work?Do you avoid taking naps in the daytime -- they contribute to a reversal of circadian rhythm even if they may be restorative in the short run ?
The history of depression and anxiety isn't terribly surprising as "mental illness" in most regards is a biochemical disorder. I have family history and I'm sure a number of others here do as well.
If you do find a doctor that could eventually prescribe drugs out of the general modern practice of psychiatry, you may expect to be run through a few other more modern agents. You may also find as noted above that a sleep study may be ordered, which if covered by your insurance may actually get to some undiscovered causes and would not be a bad thing.
I wish you luck on your search for practicioners but you should approach with your an honest full laundry list of what you have been through, as I have stated before, while a doctor-patient relationship ideally is a collaboration, don't expect to ask upfront -- in fact just dont -- for the agents you mentioned, without a history assessment.-- tidings
Jay
Posted by Phillipa on January 11, 2007, at 17:21:29
In reply to Re: miltown/equanil/meprobamate » harry_in_philly, posted by yxibow on January 10, 2007, at 3:08:51
Been on both and never had any problems stopping either med. And you will get a good night's sleep and I also drank beer on the Miltown not the chloral hydrate though. But the doc is in NC and prescribe chloral hydrate for anyone who want's it. I stopped taking ch at 20ml in about a week or so with valium. Love Phillipa
Posted by Phillipa on January 11, 2007, at 17:29:53
In reply to Re: miltown/equanil/meprobamate, posted by Phillipa on January 11, 2007, at 17:21:29
By the way I've been benzo and alchohol free for many years at a time. And never any respiratory depression. And the miltown was the med that helped the panic better than valium. So all our bodies are different. Love Phillipa ps ch was for sleep. Used to give the green capsules to nursing home patients at bedtime of the chloral hydrate.
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