Titration is the process of adjusting the dose of a drug for the maximum benefit that can be obtained without any adverse effects. When a drug’s recommended dosage has a narrow therapeutic range, titration is especially important, because the range between the dose at which a drug is effective and the dose at which side effects occur is small. The starting dose is very low, and then increased regularly until the symptoms subside, or the recommended maximum dose is achieved, or side effects occur.
[Titrate ultimately derived from Latin titulus, “inscription, label, title”.]
When changing to a different medication, sometimes one can be stopped and the other then started without overlap. However, with some there needs to be overlap, called cross-titration.
Since some psychiatric drugs may take weeks or months to demonstrate an effect (or an adverse reaction), titration is pretty much just guesswork. There is a general lack of evidence regarding the impact of titration rate on clinical outcomes. There are no specific recommendations on what titration rate is optimal for achieving rapid response while minimizing adverse effects.
The half-life of a drug is the time it takes for the amount of a drug’s active substance in the body to reduce by half. Psychiatric drugs are metabolized in the liver by Cytochrome P450 enzymes in order to be eliminated from the body. A person genetically deficient in these enzymes, or who has an ultrarapid drug metabolism, or who is taking other (legal or illegal) drugs that diminish CYP450 enzyme activity, is at risk of a toxic accumulation of the drug leading to more severe side effects.
Most antipsychotics have an average half-life of 1 day or longer; it can take up to 5 days or more for patients to reach steady-state concentrations with the same daily dose. One would not generally want to titrate the dose until a relatively steady-state concentration was reached.
One recent retrospective study of 149 hospitalized patients on antipsychotics was relatively inconclusive; it was unclear to what extent titration rate either improved symptoms or reduced length of hospital stay. Patients who continued to have their dose increased were less likely to adhere to treatment, due to increasing adverse reactions. Also, delayed adverse effects may occur if dose increases occur sooner than necessary.
Since the 1960s, there has been a large push for patients in psychiatric hospitals to be discharged as quickly as possible. In such an inpatient setting, pressure may be put on prescribers to titrate antipsychotics quickly with the hopes of reducing length of stay and hospitalization costs.
All this goes to show the general lack of predictability in the administration of psychiatric drugs, although it doesn’t even begin to address the fact that these drugs are generally addictive and harmful, and that they are prescribed for fraudulent diagnoses.
One must also keep in mind that the psychiatric industry generally pushes psychotropic drugs without regard to these considerations. This is the direct result of the unscientific psychiatric diagnoses perpetrated by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which fraudulently justifies prescribing these harmful drugs for profit in the first place.
The real problem is that psychiatrists fraudulently diagnose life’s problems as an “illness”, and stigmatize unwanted behavior or study problems as “diseases.” Psychiatry’s stigmatizing labels, programs and treatments are harmful junk science; their diagnoses of “mental disorders” are a hoax – unscientific, fraudulent and harmful. All psychiatric treatments, not just psychiatric drugs, are dangerous because they preclude finding out the real causes of mental trauma and treating those.
At best one might consider psychotropic drugs as “first aid”; they never have and never will cure any mental trauma. While the patient may be lulled into a temporary sense of wellness, whatever condition has caused the symptom is still present and often growing worse. Psychiatrists have deceived millions into thinking that the best answer to life’s many routine problems and challenges lies with the “latest and greatest” psychiatric drug.
