Should you titrate antipsychotic slowly or just get it over with and push the dose up?

The answer depends on which one you're using.

Plus, a research update on Primapexol in treatment-resistant depression.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlott Psychiatry Report.

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

Two antipsychotics that have always confused me are quittapine and zeprazidone. These two cause a lot of problems when I'm

starting them, sedation, dizziness, hypotension. So the question is, should I raise them slowly,

or does that just drag out the pain, like slowly going into the cold water of the pool one inch at a time?

The answer is different for each of them.

With zeprazadone, geodon, you want to titrate rapidly. Paradoxically, patients tend to tolerate

suprasadone better in the higher dose range. Several studies found that patients stuck with

zeprazadone longer if they started it at a high dose,

like 120 to 160 milligrams, than if they started it at a low dose, like 40 to 80.

On a similar note, many clinicians find it easier to tolerate suprasidone if they just raise it up quickly, and that strategy has

also proven successful in clinical trials. Here's how to titrate suprasidone in mania and schizophrenia.

Start with 40 milligrams twice daily with a fulmule, and raise the titrate to the treating dose of 120 to 160 milligrams by the third day of treatment.

So basically get it up there to the full dose within three days.

Quatyapine, that's a different story.

Faster titration is less tolerable here.

It brings higher risks of sedation, dizziness, agitation,

and other side effects. That conclusion is from a 2019 analysis of 18 studies that compared

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