Medication Titration: What is it and How Does it Work?

When it comes to medicating ADHD, there is no one-size-fits-all approach or a way for doctors to understand what strength of dosage will be right for you, without trial and error. This is where medication titration comes in, as a way of prescribing the right medication for you based on your symptoms but finding the right dose of that medication with minimal side effects.

What is ADHD Medication Titration?

ADHD medication titration is the systematic adjustment of medication dosage to find the optimal balance between symptom management and side effect minimisation. Doctors will first prescribe a low dose and gradually increase the dosage until the patient reports feeling relief from their symptoms. The other side of the scale can be to increase the medication too far, where side effects become extreme however the aim for both doctor and patient is to find the right balance of both.

Why is Titration Important with ADHD Medication?

ADHD medication is a stimulant and unfortunately, with this type of medication, there is no way to predict which type of stimulant will work for each patient or their ideal dose. There are two main types of ADHD stimulant medication: methylphenidates and amphetamines. Most medications are different forms of these two types of medication.

The importance of titration for ADHD medication comes from finding the right dose for each patient. In some ways, titration is a process naturally carried out by the patient when starting any medication. Once we start taking something new, we become very aware of subtle changes in our health and if those changes are severe and cause adverse side effects, then we would naturally report back to our doctor to change the dose or the strain of medication. This is the same for ADHD medication, except that it is done in a much more medically controlled way.

How is ADHD Medication Titrated?

There is no average starting dose for any ADHD medication and the starting dosage is influenced by several factors including:

• If the patient has a history of taking stimulant medication and how they have reacted to it in the past.

• Genetic and metabolic differences.

• Comorbid conditions such as anxiety or depression.

• If any treatment has been received in the past and how the patient reacted to it.

• Severity of symptoms at present.

One of the most important factors in titrating medication is to ensure that you check in with your GP or prescribing doctor often and schedule monthly appointments to review your overall health and symptom changes. Keeping a journal is the best way to keep track of your symptoms and side effects. Note down the medication and dose you are currently taking, then each day report at what time you noticed them take effect and what the change in your symptoms are, also recording any side effects you may experience.

There is no need to wait until the stimulant medication starts to take effect to notice a difference, they work immediately, and they don’t need to build up in the body to have maximum effect. However, it can take several weeks to get a good understanding of how the medication is impacting you and your behaviour, so it is recommended to wait around 8 to 12 weeks to enable your body to adjust to the new medication.

Managing and Tracking Symptoms During Titration

Before taking any ADHD medication, it is important to understand the possible adverse side effects, this should be explained to you by your medical professional. The most common side effects caused by ADHD medication are:

• Sight headaches.

• Dehydration.

• Anxiety and depression.

• Increase in pulse rate and blood pressure.

• Insomnia.

• Appetite suppression.

• Nausea and diahorrea. 

• Emotional problems or mood swings.

Tracking and logging mild to moderate side effects is extremely important to the titration process to gain the right dosage and be forthcoming with your medical professional about them. It is possible to experience more severe side effects such as heart problems, seizures, eyesight changes, delusions, manic episodes, and even circulation problems. If any of these symptoms are experienced, you must tell your doctor immediately.

If the side effects are not severe, then it is important to keep with the medication for several weeks to see if they improve with time, if they do then this could be a sign that the medication is right for you. 

Signs Your Dose is Too High

• If the side effects you experience become severe or make it hard to function, this is a sign that the dosage needs to be decreased, as side effects should always be mild if the dosage is right or almost right.

• Feeling muted or sedated, or feeling unlike yourself, also referred to as the “zombie effect”. It can be reversed by lowering the dose. 

Signs Your Dose is Too Low

• If there are no or very minimal symptom improvements.

• No side effects have been experienced since changing or starting your current dosage.

Important Points to Consider

Titrating ADHD medication should always be done with the supervision of a medical professional, but it is good to understand what signs to look out for. A rating scale can be useful, like the Weiss Functional Impairment rating scale which can help patients track and record changes easily and report them to their doctor.

Keep a Journal

The main points to take note of are if the medication isn’t working when the side effects are severe and if you feel unlike yourself. Writing each day about how you feel once you take your medication and reporting it to your doctor is the best insight into whether that dosage is right for you and points them in the right direction of what dosage or medication is right. It’s also important to track when you feel symptom relief and when the symptoms return.

What to do if You Feel the Need to Stop

If you feel the titration process becomes too difficult for you and you feel the need to stop, the most important thing to do is to speak to your doctor. It’s normal to feel this way as titration is such a long process and can play havoc with your mood but ensuring that you have adequate support through family, friends, and your medical professional is the best way to equip you for the process.

What to Avoid

• Making changes daily, medication needs time to sit in your system.

• Increase your dose past that recommended by your doctor.

• Change your dosage earlier than 7 to 10 days after being on the previous dose.

Find Your Perfect Dose with a Private ADHD Clinic in Manchester

Here at Beyond, we are a private ADHD clinic in Manchester, dedicated to helping our patients manage their ADHD so they can live their lives to their full potential. We offer a supportive medication care plan to people where medication therapy is clinically recommended. 

We will initiate and titrate the medication over the course of a few months until we agree on the optimum dose of the medication that feels right for you. We will always prescribe medications based on the best available evidence and the National Institute for Health and Care Excellence guidelines. If this is the route for you, we will ensure you have a good understanding of medications for ADHD including possible side effects. We offer clinical reviews monthly to ensure we can monitor your physical and mental health as well as review your response to medication. We use objective outcome measures to gain a greater understanding of symptom control over time which helps guide our decisions about what medication and what dose suits you better. Our main focus however is to be guided by your experiences and we will listen to your experiences and deliver a medication care plan to suit your needs. Once optimised and stabilised on medication we can either request that your GP take over prescribing with a shared care agreement, or you can continue to access prescriptions from Beyond Clinics. Whichever option you choose, you will receive annual clinical reviews to ensure your medication remains effective and your health is not negatively impacted.

The clinical team at Beyond Clinics have extensive experience and expertise in assessing and diagnosing ADHD. We offer a comprehensive pathway to assessment and diagnosis within 4 weeks or at a pace that suits you and you can access our services online or in person. Start your journey today and speak to one of our team here at our private ADHD clinic in Manchester.