asgaard

Coming off Citalopram

Sat, 22 Aug 20 12:28:16 +0000

Some time ago, I wrote about my experiences with anti-depressants.

The time eventually came for me to come off them entirely. Here's how it went.

Contents:

Background
Withdrawal
Summary

Background

I started taking Citalopram from August 2019. Citalopram was very effective for me and let me adjust the circumstances of my life that had caused me problems.

In May 2020, I decided that I'd been feeling stable and happy for long enough that I probably didn't need to still take the Citalopram and it was time to try coming off it.

Withdrawal

To begin with, I tried alternating a full dose (20mg) with half a dose in order to gradually reduce the amount in my system. This turned out to be unrealistic, and after about four days of this I was having mood swings and generally feeling pretty bad.

It's important to distinguish between relapse (i.e. you feel bad because this is the state of your body, and it needs to be treated) and withdrawal (i.e. you feel bad because of withdrawal symptoms, which should be temporary). Relapse takes more than a few days to appear, so this was definitely withdrawal.

Lesson learned: take it slower.

So I bumped it back up to a full dose for a week or so to regain my stability, and after that I started reducing the dose much slower.

I alternated a full dose with a three quarter dose, so in effect I was averaging 17.5mg. After a week or two on that, I went down to a three quarter dose daily, so I was averaging 15mg over two days.

I repeated this process for quite a while, going from a two day average of 20, to 17.5, to 15, to 12.5, to 10, to 7.5, to 5, to 2.5.

That's quite a long process. It took about 6 weeks as I was sticking at each interval for between one and two weeks.

But it worked really well. The transition was gradual enough that I didn't notice any withdrawal effects. I was probably overly cautious and could have gone down a lot quicker.

The final hurdle was going from a small dose (2.5mg) down to zero. Surprisingly (to me, at least), this was a bit rough. I had thought that 2.5mg was so low as to be effectively zero already, but apparently not. I had a few days of feeling a bit unwell physically - nausea and stomach issues (similar to the effects I experienced when starting Citalopram) and some strange minor dizziness (not enough to affect me in any practical way), but that settled quickly, and after which I was fine.

Summary

Citalopram for me has been a wholly great experience. It helped me get out of a bad situation and into a better one to the point that I didn't need it anymore.

Withdrawal was a bit slower than I expected, but by taking it slow I was able to come off it without any serious problems.

The Mandalorian

Sat, 08 Aug 20 20:01:26 +0000

The Mandalorian, or the reason I got a Disney+ subscription, is a Star Wars spinoff centred around a character known as The Mandalorian, or Mando. If you're into Star Wars lore, you'll know that the Mandalorians are a warrior people who wear distinctive suits of armour. If not, you do now. They're aggressive in the sense they fight a lot, but they see battle as their way of life. They are generally calm and easy-going outside of it. They're not quite like angry Klingons is what I'm trying to say.

Briefly, the Mandalorian is a classic western set in space. The western part of it seems to be a conscious influence. The theme tune has a slight western twang, the character is a quiet loner, but a very determined one, reminiscient of Clint Eastwood's "The man with no name" character in The Dollars Trilogy.

I see The Mandalorian get compared to The Expanse over a lot of social media. Let's be clear here: The Mandalorian and the Expanse have pretty much nothing in common except they're both modern sci-fi series. Although, calling Star Wars sci-fi after watching The Expanse seems slightly tenuous. In many ways they're polar opposites. The Expanse is a detailed and gritty series of interwoven stories. The Mandalorian, by contrast, employs a very straightfoward episodic approach where Mando (the main character) solves his problem of the week. In The Expanse, you're never quite sure who's safe and how things are going to work out. In The Mandalorian, you're always sure that Mando's going to be OK. The Expanse is quite character-rich. Mando's just a guy who wanders around and looks at things, and occasionally says "hmm". Or was that Geralt of Rivia? I get my strong and silent types confused.

Anyway, the point is that the Mandalorian is very simplistic and quite sparse in terms of characters, dialog, story-telling, well, everything really. If you're expecting a gritty, modern TV series then you're going to be disappointed. If you're expecting anything like the most recent trilogy films where everything moves at a million miles a minute then you're also going to be disappointed. It's actually quite simple and slow paced. It has a tiny bit of mystery and continuity between episodes in the form of baby yoda.

Overall it's not the most gripping TV I've ever watched, but it's certainly well made and enjoyable and I'll be watching the second series.

I have to draw attention also to the fact that The Mandalorian has done something noteable in that it has introduced a female action hero type character and made her very believable. The actress in question is an ex-MMA fighter in her late 30s, and she has the gravitas both physically and just in her general demeanour, to pull off the character perfectly. The casting here was absolutely spot on.

DIY metatarsal dome

Tue, 04 Aug 20 15:54:40 +0000

If you're here, you probably know what a metatarsal dome is and why you want one, but in case you're not clear, I'll give a summary.

What is a metatarsal dome?

A metatarsal dome is a dome shaped object that sits just behind the ball of your foot (under the heads of the metatarsal bones). The idea is that as the foot supports your body's weight, the dome supports your foot by spreading your metatarsal bones apart slightly around it, relieving pressure on the soft tissue around the metatarsals.

Metatarsal domes can be useful in managing certain types of pain in the forefoot, for example a Morton's neuroma. In the case of a neuroma, which is usually caused by nerve compression between the metatarsals, the dome helps by spreading the metatarsals and giving the nerve just a bit more space.

When I say 'dome', I am not referring to things often marketed as 'pads'. The terminology is inexact, but pads tend to be cushioned flat pads that are designed to be worn somehow underneath the ball of your foot. These do not support the metatarsals. Instead they just add a bit more cushioning, which may or may not be useful (or desirable, as they will cause your foot to point upwards slightly).

How to create your own metatarsal dome

I make my own metatarsal domes, and it's really easy.

Insoles with in-built metatarsal domes are an option, as are individual metatarsal domes, but I tend to dislike these because:

Insoles often come with other things like cushioning or arch support, which my shoe is already giving me
Insoles can make the shoe fit tighter, and tight shoes can aggravate neuromas
They often don't wear very well
Metatarsal domes seem to be a poorly defined thing. Some domes are huge, flat and wide and aren't really giving support in the right area. Others are too tiny to do anything.

Overall I find it easier to do it myself.

It's actually really easy. All you need is a shoe, ideally with a removable insole (which most if not all running shoes have), some podiatric felt and some tape (I use microporous tape because it's fairly easy to remove, but it's really not important).

The felt I use is this stuff, but you can use whatever you can find. This one is 7mm thick and has adhesive on one side.

What I do is I cut out a teardrop shape from the felt, and right in the middle of it, I add another little square (maybe 1cm square) of felt, so it's doubled up at that one point. It's not exact, the idea is just to create a dome shape, so that it's not all one height.

I stick the smaller one onto the bigger one using the adhesive on the felt, then I tape it underneath the insole.

You will need to play around with placement, which is why it helps to use tape rather than the adhesive on the felt, but basically you're aiming for the fleshy part slightly behind the ball of your foot.

The felt dome will flatten a bit under your weight when you wear it regularly, and the insole will mould itself slightly around it.

Summary and thoughts

I prefer to use tape instead of adhesive on the felt because it makes it easier to move around if needed.

I prefer to put it underneath the insole instead of on top because 1) you can tape it more easily (see previous point), 2) it protects from the mechanical friction and moisture from your foot, and 3) I suspect that the way the insole moulds itself around the felt helps create more of a 'dome' shape than having the felt above the insole.

The felt tends to come in 7mm or 5mm thickness. As it's doubled up, I have a 14mm tall dome digging into my foot, which sounds quite big. In reality, it gets squashed down pretty quickly so it's not really that big, however, if you have small feet you might prefer the 5mm.