Restarting at the Lowest Dose?!

The pharmacokinetic model versus symptom-based titration question has a practical answer: most people end up going by symptoms because theoretical models don't account for individual variability well enough to be prescriptive. How you feel at each dose level is the real data.

A single skipped dose typically does not require restarting at the bottom - the guidance to restart at the same dose after a single miss is well-documented. The insurance requirement to restart at the lowest dose is a coverage rule rather than a medical one.

Really glad to see the lowest dose working this well for you, now I'm second-guessing my own jump to .5mg this early.

My take is stick with whatever dose is actually doing the job for you, and this seems to be it.

Congrats, keep it up!! So glad life's feeling easier.

Hi there, started at a smaller amount but climbed very gradually, didn't stick to a strict monthly bump schedule and ended up holding at that starting level for a full two months. Moved up from there, held again for roughly another two months, then another stretch close to ten weeks, before eventually working my way up through several more increases over however many additional weeks it took. Sitting at the top dose currently, but lately appetite's basically vanished entirely and some nausea's crept in too. Paused entirely this past week and I'm thinking of staying off it another couple weeks before restarting slowly from a much lower amount.