Recently, I was talking with someone on Twitter and she was concerned about the side effects of psychiatric medication X. I asked her what her starting dose was for the psych medication and she said 15 mg. Now, I’m not a doctor, but I can tell you two things:
- That is ridiculous.
- That will certainly make the patient stop the medication early due to side effects and never even find out if it works.
Psychiatric Medication Starting Doses
There are two psychiatric medication starting doses – the one given by the drug company and the reasonable one. Sometimes they are the same, but often they aren’t. I’m honestly not sure why drug manufacturers insist on being so aggressive in their starting dosages but I suspect it has to do with the fact that they want their medications to work sooner and thus look better in studies. If I gradually increase a medication over three weeks that cuts into the time we have to study the medication at a full dosage (when it will likely work). And in all honesty, many medications take far more than three weeks to safely get on.
And 15 mg for medication X is aggressive even by manufacture standards (which recommends between 10 mg and 15 mg). It is not at all reasonable unless the person is in a hospital or acutely psychotic or suicidal. And it most especially isn’t appropriate for a person already concerned about side effects.
Doctors Sabotage Patients
So the way I see it is this doctor is sabotaging his patient. He’s prescribing a starting dose that she likely won’t tolerate, she will, quite reasonably, want off the medication, and neither one of them will ever know whether the medication would have been useful. And I can attest to the fact that this can be a very useful medication when used properly.
And this angers to me to no end because it gives patient the experience that medications are “bad” due to the severe side effects and “don’t work” due to the fact that they don’t stay on them long enough to find out.
And what really ticks me off is that it doesn’t have to be this way.
Mental Health Medications – Low and Slow
I said in my last article the way to start a medication is to start on an extremely low dose and very slowly increase it. And that is the best advice anyone taking medication can hear (if you ask me). Sure, it might not work, you still might find too many side effects or the medication might not work for you but at least that way you can give it a fighting chance.
And I know, it’s impossible for the average person to know what a reasonable starting dose is. After all, 15 mg seems low. But all I can recommend is telling your doctor that you are very sensitive to medication and you would like to start on the smallest dose possible. Because it’s easy to increase the dose is you find there are no side effects, it’s really difficult to lower the dose once you already have a prescription in-hand.
So don’t let your doctor sabotage your medication trial. You deserve an easier way onto medications and you deserve a less painful experience. Speak up for yourself. It might be the only way that will happen. (A good indicator of a low starting dosage is looking at the lowest dosage the manufacturer makes.)
(Obviously, good doctors, particularly psychiatrists, know what a good starting dose is but someone who doesn’t treat your type of illness, or use that type of drug, every day will likely just go with whatever the manufacture suggests, which is generally where the problem is.)