The Process of Finding the Right Medication and Dose

You’ve started a new medication, and you’re waiting for it to work. A few weeks go by, and you don’t feel much different. Or maybe you do feel a little better, but you’re also dealing with some annoying side effects. You might start to wonder: Is this the right medication for me? Is this as good as it gets? This uncertainty is a normal part of the treatment process.

At Televero Health, we want our patients to understand that finding the right psychiatric medication is often more of a process than a single event. It’s not like taking an antibiotic where one standard dose works for almost everyone. People’s brains are incredibly diverse, and finding the treatment that fits your unique chemistry can sometimes take a bit of fine-tuning.

Why Isn’t There One “Best” Medication?

While we know a lot about how different classes of medication work on the brain, we can’t yet predict with 100% certainty how one individual will respond to a specific drug. Your personal response to a medication is influenced by a complex mix of factors, including:

• Your Genetics: Your genes can affect how your body metabolizes, or breaks down, a medication. Some people are “fast metabolizers” and may need a higher dose, while “slow metabolizers” may be more sensitive to side effects and need a lower dose.
• Your Brain Chemistry: The specific nature of the neurotransmitter imbalances in your brain will determine how well a medication that targets a certain chemical, like serotonin, will work for you.
• Your Medical History: Other health conditions you have and other medications you take can all influence the effectiveness and side effects of a psychiatric drug.

Because of this individual variability, the process of medication management is systematic and methodical. It’s a partnership between you and your psychiatrist, based on careful observation and open communication.

The “Start Low, Go Slow” Approach

When you start a new medication, your psychiatrist will almost always begin with a low “starter” dose. The purpose of this is to allow your body to get used to the medication gradually, which helps to minimize potential side effects. Rushing the process by starting at a high dose is more likely to cause discomfort and lead you to stop the medication before it has a chance to work.

After a period of time on the low dose, your doctor will check in with you. Based on your response and any side effects you’re having, they will decide whether to slowly increase the dose. This process of gradual dose adjustment is called titration. The goal is to find the “sweet spot”—the lowest effective dose that gives you the most symptom relief with the fewest possible side effects.

When Is It Time to Make a Change?

How do you know if you need to adjust the dose or switch to a different medication? Your psychiatrist will be looking at a few key things:

• Efficacy: Is the medication working? Are your symptom scores on assessments like the PHQ-9 improving? Are you noticing a real-world difference in your ability to function?
• Tolerability: Are you experiencing side effects? If so, how bothersome are they? Sometimes, a medication might work well for your mood but cause side effects (like fatigue or weight gain) that are too difficult to live with.

If you’ve been on a therapeutic dose of a medication for a sufficient amount of time (usually 6-8 weeks) and are not seeing enough improvement, or if the side effects are unacceptable, your doctor will discuss making a change. This might mean:

• Augmenting your current medication: This involves adding a second medication that works in a different way to boost the effect of the first one.
• Switching to a different medication in the same class: If one SSRI doesn’t work for you, another one might.
• Switching to a medication in a different class: If SSRIs aren’t effective, your doctor might try an SNRI or another type of antidepressant.

This process requires patience, but it is a structured and evidence-based approach. Try not to get discouraged if the first medication isn’t a perfect fit. It doesn’t mean that treatment won’t work for you. It just means you haven’t found the right key for your lock yet. By communicating honestly with your provider about what you’re experiencing, you can work together to find it.

Key Takeaways

• Finding the right psychiatric medication and dose is a process that can take time and adjustment due to individual differences in genetics and brain chemistry.
• Psychiatrists use a “start low, go slow” approach, gradually increasing the dose to find the most effective level with the fewest side effects.
• A decision to change the dose or switch medications is based on efficacy (is it working?) and tolerability (are the side effects manageable?).
• Patience and open communication with your provider are essential. It’s normal to have to try more than one option to find the best fit for you.

Ready to take the first step? We can help. Get started with Televero Health today.