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Slow titrators

Every step up gives me three bad days like clockwork

Started 22 April 2026 · 15 replies · 111 hearts · read 1.7k times

HalCambridge, UK · 22 April 2026
3 months ago

Every step up gives me three bad days like clockwork — putting it in its own thread so it does not get lost in the check-in.

Long one, sorry. I have been chewing on this for a fortnight.

The thing that has surprised me most about this stage is how much of it is about other people rather than about me.

I have written down what has happened, in order, because I find that more useful than my own summary of it. The summary always sounds either better or worse than the weeks actually were.

The practical side has settled and the rest of it has not, and I would like to hear how other people at this stage handled the part that is not practical.

The number in the title is the actual number: three, not a round figure I reached for because it sounded about right.

Anyway. Thank you for reading this far. Any experience of this stage gratefully received, and I will come back and say what happened.

37

GwendaEbbw Vale, UK
#1

What I found hardest was other people's timelines, not my own. Once I stopped reading week-by-week accounts elsewhere, my own pace stopped feeling like a deficiency.

7

TomásFacilitatorLisbon, Portugal
#2

Adding a note rather than an answer: the guides cover the practical side of this stage well, and the thing this thread is doing that the guides cannot is keeping somebody company.

12me too 9

BevanSwansea, UK
#3

The one thing I would say is to write down why you are holding where you are. Six weeks later I could never remember whether it had been a symptom, a work trip or just nerves.

9

GwennoPwllheli, UK
#4

Gwenda — yes, and the bit that took me longest to accept was the next part.

My prescriber described the aim as staying on treatment comfortably rather than reaching a particular step, and once I heard it that way the pressure evaporated.

4

FlorrieBlackburn, UK
#5

You have said something a lot of us have not managed to. Thank you.

3me too 4

IdrisCardiff, UK
#6

I hold at a step for as long as it is still teaching me something. When a step gets boring, that is usually my sign to talk about the next one.

6

BroganCumbernauld, UK
#7

Idris — yes, and the bit that took me longest to accept was the next part.

I was surprised how much better my reviews went once I arrived with a clear account of why I wanted to stay put. It turned a negotiation into a plan.

6

DoraUtrecht, NL
#8

Somebody asked me whether slow titration is just fear management, and honestly, partly. It is also symptom management and life management, and I have stopped ranking those.

8

BrammyBelfast, NI
#9

The thing that finally let me relax was realising that staying put is an active choice with a reason behind it, not a lack of a decision.

7

GwynethAberdare, UK
#10

Picking up Dora’s point rather than starting a new one.

I went back down a step once, deliberately, and it was not a failure. It was the most sensible fortnight of the year and my prescriber agreed without hesitation.

7

HalCambridge, UK
#11

Dora — yes, and the bit that took me longest to accept was the next part.

Every step up for me came with about ten days of adjustment and then nothing. Knowing that the ten days were coming made them much easier to sit through.

7

GwendaEbbw Vale, UK
#12

Going slowly did not stop things changing for me. It just meant the changes arrived one at a time and I could see each one.

7

HeddaCopenhagen, DK
#13

My honest reason for going slowly is that I have a job I cannot be unwell in, and that is a perfectly respectable reason that I no longer apologise for.

6

TomásFacilitatorLisbon, Portugal
#14

Facilitator note: this circle is deliberately quiet about numbers and a couple of replies have started to drift that way. Nothing wrong intended and I am steering us back.

16

GwennoPwllheli, UK
#15

A practical note: I keep a single line per step with the date I started it and the date anything settled. It is the most useful piece of paper I own for these conversations.

6