Kalakarp

Feeling very seen by fish today.

Ravimid

Reviewing all the medications I’ve ever been on. This will be intensely specific to my experiences; YMMV! Content note: mentions of mental illness, suicidal feelings, assault, sex.

mental health(-ish)

• escitalopram
  • A day or two after starting it I felt like the world had colour in it again for the first time.
  • Not very effective for anything other than “light depression” (?) imo.
  • Prescribed initially for depression/I’m 23 And Life Is Generally Hard, was on it for two years.
  • Later prescribed in an attempt to counter chronic idiopathic nausea, to no effect.
• quetiapine
  • Wow! I didn’t know what “suicidal compulsion” actually felt like until I took my first dose. That was also my last dose.
• desvenlafaxine
  • Going up from 100mg to 200mg, I’d just stop knowing how to form sentences halfway through them.
  • Effective on moderate GAD-type symptoms.
  • Coming off it was, contrary to all expectations, pretty uneventful. Except that for about three weeks, all I could smell was blood, with no apparent source.
• brexpiprazole
  • If you close your eyes, you will fall asleep. At any time.
  • Definitely calm.
  • Much too sleepy to continue, but it definitely brought me down after increasingly intensifying distress post-sexual assault.
  • As with any antipsychotic/dopamine antagonist, not particularly inclined to remain on one for any longer period of time.

  • At the time I was put on it, the only article in the literature about it had the (actually!) reassuring title: “Brexpiprazole: so far so good”.

• lamotrigine
  • Unclear whether I felt much of anything on this, even after three years at 200mg.
  • Coming off it: ANGER. Wow. (Remember to titrate; SJS can be triggered both on increase and decrease, apparently.)
  • After coming off it: oh my goodness I suddenly feel like being creative again.
• mirtazapine
  • eeeeeeeepy and hunnnnggggy.
  • Extremely and rapidly effective with chronic idiopathic nausea. Nothing else worked.
  • Weight gain pretty woof. That said, the weight I gained on it, I managed to drop while still on it.
  • I don’t remember if I maxed out at 30mg or 45mg — at higher doses the dissociation made memory very wonky.
  • Discontinuation meant a lot of rebound nausea and anxiety. It took me about 4 attempts, over several years, with various titration schedules; the successful attempt was just dropping from a sustained 15mg to 0. Trying to step it down at 7.5mg only prolonged the unpleasantness and resulted in aborting the attempt — subtherapeutic but side-effects remain.
• duloxetine
  • Really pleasant and noticeable, even at 30mg. Everything feels a bit lighter, and mild neuropathy totally neutralised.
  • Night sweats :( Became intolerable not long after increasing to 60mg, and didn’t subside after reducing again.
  • Discontinuation was reasonably uneventful; (manageably) shorterer temper and very mild nausea.
• gabapentin
  • I just started this! Early effects for neuropathy are promising. Slightly dissociative/floaty.
  • Was always curious about gabapentin/pregabalin since I first started having noticeable anxiety, so I’m glad I’ve gotten to try it. Definitely somewhat calming.
• diazepam
  • It is what it is.
  • Avoid taking on an empty stomach if you’re having issues with nausea — it can get so much worse.
  • I treat it with extreme caution. I’ve read so many personal horror stories about benzodiazepine dependence and it takes a really bad time for me to consider taking even 2.5mg. I’ll go up to 5mg if need be, but in general would refuse to take it if I’ve had any separate dose within the last week.
  • For the above reason, despite having been in some very bad places (where doctors were prescribing it in larger quantities at a time), I’ve maybe taken 100mg total over the last decade. Just not worth the risk.
  • Even less inclined to if I’ve taken stimulants on the same day, but I’ve only ever once (namely, in a life-threatening situation) had to even consider diazepam since getting medicated for ADHD 2 years ago. Funny how that works!
• temazepam
  • Not a fan; taken a handful of times ever, mostly at music festivals.
  • I have chronic insomnia and this is just not any part of an answer to it.

ADHD

• dextroamphetamine
  • Current weapon of choice. Calm, alert, focussed.
  • Latent anxiety is reduced a lot, probably because it lets me have some agency in my own head.
  • My doctor gradually increased my dose to 10mg, 4 times a day. This is absolutely fucking nuts. Don’t do that.
  • After 1.5 years I’ve settled on 2.5mg, twice a day at a 4 hour interval, and it’s completely adequate.
  • If I’m having a very long day, a third dose is fine too. 2.5mg doses are very light.
  • For a long while there I was finding myself increasing my dose by 2.5mg or 5mg (per day) every week or so since the tolerance builds so rapidly. You will deplete every last monoamine you have like this. I managed to tolerate 40mg/day (after a buildup) for about two days before I crashed. Do Not.
  • Sometimes 2.5mg doses can feel a little bit too light, but my health right now is such that increasing even just one of the doses leaves me feeling empty the next day. I’m glad to have something that works.
  • Small doses is also good because I’ve yet to see a psychiatrist in Estonia to get a prescription here, so I’m working through my stock from Australia very slowly. As far as I can tell, currently authorised dextroamphetamine products haven’t been imported to Estonia, so it’s unclear how easy it’d be to access it.
  • There’s this one, but it’s only available in 10mg? And searching for it online shows up something with the same name, but it’s atomoxetine instead? Very suss on that.
• lisdexamfetamine
  • Hrrrrrrr. Not a fan.
  • Something about this leaves me feeling depleted at any effective dose. I think I like the little humps I get between dex doses — lisdex is just exhausting, and an absolute pain if you wake up late.
  • 30mg? Not enough to feel anything — too spread out.
  • 40mg? I kinda feel something. It’s a bit eh.
  • 50mg? Yeah, okay, maybe this starts to feel like I’m having an OK dose of dex — I can think, focus, actually listen to people when they talk to me. I feel like I am spread very thin.
  • 60–70mg? Effective — wired — but also I start sleeping longer and longer because of how exhausted it leaves me, making my doses later and later, in turn fucking up my sleep schedule; not to mention the pervasive sense of Bad that starts to accumulate. No ty.
  • My god. I tried combining ~low dose lisdex with a small dex booster in the afternoon. Quick way to know what it feels like to fry your brain. You can do all the stimulant equivalence arithmetic you want, it just doesn’t add up that way.
  • If I was offered lisdex or nothing, it’s not clear to me that I would take it.
  • In general, I’m not sold on long-acting stimulants. I get the abuse angle (it’s what I was put on first, for this reason), and I do read stories of folks who find it legitimately helpful — like most others with ADHD, I regularly forget to take my stimulants — but there was no way to make it work for me. It’s too inflexible, and there’s some (possibly fear-mongering) news out there that suggests long-acting stimulants carry a greater risk of psychosis than short-acting ones?
• methylphenidate
  • Very conflicted on this. (Annoying that it’s so much more readily available, especially in Europe.)

  • Possibly neuroprotective vs. an active COVID infection! I was on MPH when I finally got COVID, and was wondering if I should keep taking stimulants through a moderately bad case of it or not. This article swayed me in favour of maintaining it:

    Remarkably, several drugs acting on receptors to neurotransmitters also appear to decrease hospitalization risk: rizatriptan (OR=0.118, CI 0.003 to 0.750), bupropion (OR=0.399, CI 0.136 to 0.976), and methylphenidate (OR=0.444, CI 0.178 to 0.972).

    I’ll take an OR of 0.444ish. I had to argue with a doctor from the government(!) to avoid hospitalisation, but avoid it I did.

  • I haven’t gotten a sense for how shared this is, but I get noticeable euphoria when starting on 10mg, and it makes one very inclined to up the dose when you stop getting that response after a few days.
  • Dragon-chasing aside, MPH consistently produces a sort of global “bad” sensation that I just cannot with. Even with the initial euphoria, it’s still noticeable — there’s just this unpleasant but persistent background qualia, almost a certain flavour of experience. Unclear if shared or just me.
  • All that notwithstanding, from 10mg it feels 70–80% as effective as dex at ~equivalent dose (5mg dex ≈ 10mg MPH).
  • 5mg didn’t feel like it had any impact at all, but that was a while ago, and I’d revisit it if I had to.
  • If I was offered MPH or nothing, I would probably take it.
  • If I was offered MPH or lisdex, I would probably take MPH.

vascular

• propranolol
  • Very chill. Noticeable sensation in the chest.
  • I once had a kind of shock reaction to a piercing which resulted in a really high heart rate, intense and sudden nausea, cold shivers all over, and me on the floor. (I find lying on a cold hard floor fixes most things.) The next time I went for a piercing I took 10mg propranolol before and it was easy.
  • Initially prescribed to try to combat panic disorder/idiopathic nausea. It at least brought my heart rate down and made it possible to eat again.
  • Later took it for arrythmia on demand. Reasonable at this — would often get painful(!) arrythmia at night which would make sleep impossible, and leave me feeling sore (and exhausted) the whole next day. 10mg propranolol would usually convert it within half an hour.
  • 100–200mg magnesium seems to work for that too.
• nifedipine
  • Certainly feel that one on starting. Not like I didn’t already have some orthostatic hypotension …
  • Take for Raynaud’s in the Australian winter/unspecified (micro?)vascular issues. Recently my legs have been feeling Not OK and so I’ve restarted it. Unfortunately, we don’t seem to have the modified-release ones here, so I have to dose twice a day.
  • Doesn’t impair exercise.
  • Not to be combined with propranolol (or magnesium, possibly).

gastric

• esomeprazole/omeprazole
  • Unremarkable. Not super effective for (probably stress-induced) heartburn/reflux.
  • Was also prescribed it at one point as an attempt to help with idiopathic nausea — no response.
• ondansetron
  • This is meant to be the Big Guns when it comes to nausea, and it did nothing for mine.
  • I was scrambling to find something that would work — it’d slowly subsided on desvenlafaxine in the first instance, and I’d tapered off that after about a year and was all good. A particularly bad anxiety attack provoked it into a full reoccurrence, which was terrifying. I wasn’t inclined to retry stepping up on desvenlafaxine and waiting it out to see if it’d work again — I felt like it might’ve also just been a matter of time, then, as it remitted only after more than a year of (essentially constant) suffering! — so I looked for other things.
  • My research lead me to mirtazapine; there’s a number of different ways in which it’s antiemetic. My GP at the time was happy to prescribe it for me based on my conviction, but wanted to try ondansetron first to see if it’d work as a circuit breaker (and thus avoid necessitating something taken over a longer time). Alas.

cannabidiol

Usual effects of cannabis products apply.

• THC oil
  • First trials found it to be extremely intense and disorienting.
  • Retrying years later (once I was using flower more medicinally and regularly), found it to be a nice way to dose THC in a more controlled manner, without the usual associations that come with vaping bud (i.e. “Time To Relax, And Perhaps Eat Much Šokolaadi.”)
  • Slower onset can be quite pleasant.
• CBD oil
  • First trials found it to make me feel generally unwell!
  • Later trials together with THC oil found it to be a nice way to dampen some aspects of the THC high, if needed.
• cannabis flower
  • Nothing much to report here. Australian medicinal cannabis was decent, actually decent value (per volume), and there was a reasonable variety of strains to choose from, which improved over the years. Doctors were not inclined to gatekeep (perhaps concerningly so) or judge.
  • Driving was a bit nerve-wracking; regular use builds up a level in the blood which can be detected by roadside random breath tests even if you’ve not used any that day, so I was pretty much always on alert/police-avoidance mode. It was a pretty strong deterrent, but I lived in a public transport deadzone so there wasn’t much choice.
  • This may be changing soon in Victoria!

misc

• naproxen
  • Prescribed for leg pain which was suspected referred back pain.
  • Came in a combination form with esomeprazole because COX inhibitors be wild.
  • No effect.
• tadalafil/sildenafil
  • Mildly effective for antiandrogen-related difficulties with penetrative sex.
  • Not a fan of the way these make my heart feel; wouldn’t opt for tadalafil again since it’s just the same but for days instead of hours.
• emtricitabine+tenofovir
  • PrEP. This is important, good stuff!
  • Mild nausea during the first two weeks of starting it, otherwise side-effect-free.
  • Been on and off it a half-dozen times over the last 8 years as my risk factors have increased or decreased. I have nothing but good things to say about PrEP.
  • Caution while travelling; less progressive governments may infer any number of things about you based on the medication you carry.

HRT

• oestradiol valerate
  • Standard first-line transfem primary HRT.
  • In the first few years I seemed to manage decent levels while increasing to 8mg/day, but over time I seemed to stop being able to absorb oral oestrogen and had to switch off.
  • Not particularly sad about that: other forms are less work for my liver.
• oestradiol gel
  • Absorbs well. A little bit annoying to make your skin sticky twice a day but wycd ¯\_(ツ)_/¯
  • Seems to be widely available; the last few years have had many HRT shortages, but I’ve not had issues with this.
• micronised progesterone
  • Preferred over synthetics (e.g. levonorgestrel) due to much reduced blood clotting risk, fewer negative mood side-effects.
  • Helpful for sleep — take at night.
  • First time I started it, within days I was sobbing (+) while watching Frozen. Really unlocks some emotions.
  • 200-300mg is an actual recreational high (N.B.! loss of consciousness/respiratory depression may result at extreme doses).
  • Also an antiandrogen!
• spironolactone
  • At least in Australia, first-line antiandrogen.
  • Diuretic and generally not fun. At the doses required for me, also precipitated pretty intense low mood which abated upon discontinuation.
• cyproterone
  • Antiandrogen. Extremely effective in even tiny doses.
  • My doctor started me on 50mg a day. I don’t have a good analogy for how nuclear this is.
  • May need more initially to get levels down, but (depending on prevailing E levels) you may be fine with 12.5 mg once a week, i.e. 3.6% of the dose I was started on.
  • Some folks report low mood on cypro; it hasn’t been an issue for me.

VyxOS

Cross-post from lottia notes.

Sada päeva

Yesterday was our 100th day in Estonia. Taking a little bit of stock of what we’ve managed:

• Visited the 4 largest cities in the country.
• Rented an apartment in the biggest one!
• Furnished what the apartment didn’t come with.
• Shipped our things from Australia. (Maybe a month off those arriving.)
• Got our motorcycles; put 900km on each.
• Got medium-term visa for A, and long-term one applied for.
• Got our medications prescribed locally.
• Financial/bureaucratic overhead.
• Changed my name and got new ID.
• Got onto a good family doctor’s list.
• Kept in touch with families and psychologists.
• Vaccinations.
• Saw the border.
• Went to a cat café.
• Went to sauna.
• Concluded jaanipäev with clothes smelling deeply of bonfire.
• Went to a live show (Estonian).
• Went to a live show (non-Estonian).
• Walked about 500km.
• Taken a lot of public transport.
• Met a range of people.
• Spoken quite a bit of Estonian.
• Kept up with projects.
• Finished a diary!
• Grew a lot.

Activity period

Time travel

Cross-post from lottia notes.

Python still surprises

After the better part of 20 years working with Python, it still managed to surprise me today.

I’m so used to languages treating x += y et al. as pure sugar for x = x + y that it skipped my mind that some don’t.

I’m not surprised that you can override them separately in some languages (e.g. I simply assume this to be the case in C++, and on checking it turns out to be true — but that seems fair enough given the scope of the language), but I really am so accustomed to them being only sugar in Ruby that I assumed the same would hold, at least in effect, in Python.

Thus my surprise on some_list += x modifying some_list in place (unlike some_list = some_list + x), but once observed, I realised there’d be a separately-overridden operator function — namely __iadd__ — and so I figured it “had” to be that way.

Or did it? I then found myself assuming it’s because these operators can’t actually reassign the receiver, but in fact they can and do: the return value is what’s assigned to the LHS. So it’s just a matter of convention.

sint

Notes.app, kell 08:03:

my new theory is that satan Crept into this world through signed integers

zxxrtl

I’ve been getting back into using CXXRTL and Zig together, so I’ve extracted and rendered somewhat reusable the bindings I made to use them together!

zxxrtl uses CXXRTL’s C API to provide a somewhat idiomatic way to access, manipulate, and respond to events happening in the design. Its README covers the setup — it’s a bit involved as it’s necessarily something of a build system, but once you’re done it’s good to go and flexible enough to be instrumented from a higher build system.

I’m going to paste the example usage here; this doesn’t use the Sample API for edge detection, and just drives the simulation while optionally recording VCD:

const Cxxrtl = @import("zxxrtl");

// Initialise the design.
const cxxrtl = Cxxrtl.init();

// Optionally start recording VCD. Assume `vcd_out` is `?[]const u8` representing an
// optional output filename.
var vcd: ?Cxxrtl.Vcd = null;
if (vcd_out != null) vcd = Cxxrtl.Vcd.init(cxxrtl);

defer {
    if (vcd) |*vcdh| vcdh.deinit();
    cxxrtl.deinit();
}

// Get handles to the clock and reset lines.
const clk = cxxrtl.get(bool, "clk");
const rst = cxxrtl.get(bool, "rst");  // These are of type `Cxxrtl.Object(bool)`.

// Reset for a tick.
rst.next(true);

clk.next(false);
cxxrtl.step();
if (vcd) |*vcdh| vcdh.sample();

clk.next(true);
cxxrtl.step();
if (vcd) |*vcdh| vcdh.sample();

rst.next(false);

// Play out 10 cycles.
for (0..10) |_| {
    clk.next(false);
    cxxrtl.step();
    if (vcd) |*vcdh| vcdh.sample();

    clk.next(true);
    cxxrtl.step();
    if (vcd) |*vcdh| vcdh.sample();
}

if (vcd) |*vcdh| {
    // Assume `alloc` exists.
    const buffer = try vcdh.read(alloc);
    defer alloc.free(buffer);

    var file = try std.fs.cwd().createFile(vcd_out.?, .{});
    defer file.close();

    try file.writeAll(buffer);
}

Hopefully this is useful to someone else!

fren