In an idyllic world, a patient who requires psychiatric medications would only need one medication and it would be very easy to determine which medication to use and what dosage a person requires.
However, it is far more common for a patient to have to trial several medications, depending on their medical history and their diagnosis. Some patients may be do best on a combination of medications that help control different aspects of their diagnosis.
When psychiatrists talk about adjusting medications, they will often discuss the process of cross-titration. Simply stated, cross-titration is the process where a psychiatrist considers:
A patient's current medications and dosages
The upcoming medication plan to be trialed next
How to safely transition from the current medication plan to the goal medication plan.
Sometimes the goal plan is the discontinuation of medications all together. In order to successfully cross-titrate a patient from one medication plan to the next, it's important for a psychiatrist to work closely with the patient to develop a plan that is both well-understood and that the patient believes they can adhere to. While a psychiatrist may have an idea of how to safely navigate these transitions, several factors go into successfully planning a cross-titration, including:
The target uses of various medications
The side-effect profiles of various medications
How quickly medication changes need to be made
Side effects that the patient may be more sensitive towards
Lifestyle challenges that affect medication compliance
Household budgets for prescriptions
The patient's experiences in the past with medications that might have similar effects on the body (also known as mechanism of action)
The planning that goes into cross-titration is often why a physician will advise that medications not be suddenly stopped. Rather, people are encouraged to reach out to their physician and describe what is happening that makes them want to stop or change their medication. This information can be taken into account when planning how to transition someone to a less problematic medication or off of medication completely. #MentalHealthMatters #Psychoeducation #Psychiatry
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