Are you curious about titration and wondering whether or not it could be beneficial for you when starting a new medication? Whether you have come across the term before and would like to know more, or it’s your first time hearing about it, we’re covering all things medication titration; what it is, why it is done, how it works, when it’s used, and how to know if you should ask your doctor or psychiatrist about it.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have any questions at all about the medication you are taking, we’re here to help you learn everything you need to know.

What is medication titration?

Titration is a technique commonly used in healthcare whereby medication is introduced or interrupted slowly over time, building up from a lower dose to higher doses, or reducing a dose until the patient can stop taking the medication altogether. This allows the patient’s body to adjust to the physiological and chemical reactions caused by the introduction or interruption of medication.

For example, a patient with ADHD may be prescribed a small dose of stimulants to begin with. Depending on their response, have their dosage increased as needed to safely achieve the desired effect. A patient with antidepressants coming towards the end of their treatment may have their dosage gradually reduced over time to manage potential withdrawal effects.

Since everyone responds to different medications in their own way, a medical professional will use titration to determine the best dose of a medication based on the patient's age, underlying health conditions, body weight, immunity, allergies, and more.

Why is medication titration done?

Ultimately, the desired outcome of medication titration is to achieve the ideal balance for the patient so they can feel as healthy as possible, which means administering the lowest possible dose of a drug while still creating the results they want, such as minimal side effects and maximum effectiveness in treating their condition.

How does medication titration work?

Medication titration can be done in a few different ways, but it typically begins with a medical professional administering a low dose of the medication, which is gradually raised until the best balance is found; the dose is increased until the medication starts to become effective in treating the patient, and is further increased until the maximum effectiveness is found, while having the fewest possible side effects for the patient. If medication is being titrated downwards, this will be done in reverse.

Since side effects are often different for everyone, it involves a lot of personalisation and tweaking to get the balance correct. There are three ways this can be done:

1. Up-titrating — This means the dose of a medication is increased over time until the required lab-standard effectiveness is achieved and/or the patient’s symptoms have been relieved.
2. Down-titrating — This means the dose of a medication is decreased over time until any side effects have been reduced to a point of manageability for the patient.
3. Cross-titration — This is also known as cross-tapering, and it means the titration can be performed in either direction, and patients may be switched between two different kinds of medication in order to achieve the right balance. In this instance, extra care should be taken when cross-titrating things like antipsychotic medications in order to avoid drug interactions and risk of relapse.

Titration is also done based on the patient’s individual risk factors. A 2021 study called The art and science of drug titration by Aisling R. Caffrey and Eric P. Borrelli explains that when using medication titration to treat things like diabetes and hypertension, deciding how much of a certain medication you can give to a patient means compromises may need to be made.

For example, a degree of hyperglycemia (high blood sugar) may be allowed in order to decrease the risk of hypoglycemia (low blood sugar), while a degree of hypertension (high blood pressure) could minimise the risk of hypotension (low blood pressure), and so on.

Is medication titration the same as a dose adjustment?

Not quite. Medication titration is different from a straightforward dose adjustment because a dose adjustment tends to be required to maintain effectiveness alongside basic changing factors such as the patient’s age, their weight, any other medications they are taking, and more.

Medication titration, on the other hand, focuses on changing the dose based on the patient’s individual clinical and pharmacogenetic parameters, and looks at how the individual’s DNA affects the way they respond to drugs. In other words, it is much more precise, cannot be mass-prescribed, and is often thought of as somewhat of an art as well as a science.

Titration is highly individualised to the patient, so the standard do’s and don’ts of prescribing a specific medication do not apply, and a little more creativity is needed from the medical professional.

In many cases, recommendations are used as a starting point for titration, but it quickly becomes up to the medical professional to use their expertise and knowledge of the patient to find the right balance.

When is medication titration used?

There are many scenarios where medication titration may be used to achieve the desired outcome of a drug.

Some examples of common medicines that need titration include:

• Antidepressants — used to boost the activity of particular brain chemicals to treat depression
• Antipsychotics — used to manage psychosis and a range of psychotic disorders
• Stimulants — used for conditions such as ADHD and narcolepsy to increase activity of the central nervous system

For the above medical conditions and others, titration is necessary to find the right balance of medication so the patient sees the biggest benefits from it, with little to no side effects.

What can I expect when going through medication titration?

Titration always works differently for everyone, and can take a while to find the right balance depending on the individual, the medication and the condition that needs treating.

As an example, using titration in ADHD medication for children may involve the following steps:

• A specialist will take into account a child's height, weight, symptoms, daily schedule and family needs to determine the best course of medication
• The parent/guardian will be asked to increase the child’s medication slightly every 1 to 3 weeks as needed (with a minimum of 1 week being required to see changes)
• The parent/guardian and teachers should keep a log of side effects to share with the specialist at regular intervals. If any do occur, it’s often advised to wait these out if possible to see if they settle (sometimes side effects last only a short while)
• The cycle should continue until the child’s ADHD symptoms are controlled in the best way with the least amount of side effects (this could take 2 or 3 tries at titration before striking the right balance)
• A follow-up with the specialist should happen around every 3 months (or when asked to) to check in on the dosage

A strong partnership between the specialist and the patient is also necessary to see the best results of titration, because together they must continue to review the benefits or side effects of the medication based on what works for their lifestyle.

How do I ask my psychiatrist about medication titration?

There are many reasons you may be interested in medication titration, for example:

• You have been advised to try a medication that can cause significant side effects and you would like to begin the treatment in the best way to avoid these if at all possible
• You have had a bad experience taking a medication in the past and would like a more tailored approach to starting it again
• You have been advised that titration is the best way for you to begin a medication but you have questions about why it is taking so long to find a balance

If any of the above are true for you, or if you have your own reasons for learning more about titration, you can speak to your doctor or medical professional. If you are interested in finding out more about medication titration that specifically concerns mental health conditions, a psychiatrist may be the best person to help answer your questions, and you can book a free 15 minute consultation with us to find the right fit for you and discuss potential next steps.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private psychiatric assessments to helping you find a psychiatrist near you for support on your journey.