You know the drill. Start low and go slow, but sometimes the usual laws don't apply, and we'll cover them on part two on how to start a psych man.

Welcome to the Carlet's Psychiatry podcast, keeping psychiatry honest since 2003.

I'm Chris Agen, the editor-in-chief of the Carlatte Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Last week we reviewed the most important part of starting psych med, educating patients about

what to expect and collaborating with them to choose a medication. For most medications,

titration schedules are also collaborative. There's no right way to start them. And whether you go

fast or slow depends on whether your patient wants to recover as fast as possible or avoid as many

side effects as possible. But there are some meds that benefit from a little extra skill, and that is what

the rest of this series will focus on. You'll learn expert titration strategies for buproprion,

antipsychotics, praisesin, lithium, lemotrogen, carbamazepine, valproate, and admoxatine.

At the end of each episode, we'll bring you a research update from a daily psych feed.

Today's paper is on antidepressant metabolism in Asians.

To join the feed, search for Chris Aiken MD on LinkedIn, Twitter, Facebook, or Blue Sky.

It's easy to get burned while starting antipsychotics. Too much acethesia, sedation,

dizziness, or a fall, and your patient may never want to take them again. So, unless it's an urgent situation, I usually start them at the lowest possible dose, much lower than the PDR recommends.

After all, most of the antipsychotic studies that inform the PDR's dose schedules were done on

an inpatient unit, where rescue benzos and supportive nurses are ready to assist if trouble arises.

Most of us have probably already incorporated this pearl into our practice,

but there is still a stumbling block to look out for, and that is drug interactions. Antipsychotics

are often added to meds that can double or quadruple their levels, and I've seen some

terrible cases of acathesia and EPS result from these interactions.

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