Splitting the difference — what my prescriber offered instead

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.

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.

The schedule on the box is a default, not a deadline. My nurse said that in my second month and it reorganised how I thought about the whole thing.

What worked for me was agreeing a review point rather than a step-up date. We would look at it in eight weeks and decide then, which took the whole thing out of my head in the meantime.

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.

Not a solution, just company.

Coming back a year later to say the slow route held. I am still on treatment, still comfortable, still having ordinary weeks. That was the entire point of going slowly.

I have been at the same step for eleven months, agreed with my prescriber, and it is the best decision I have made in this whole business. Slow was not a compromise, it was the plan.

Saying it out loud helps other people say it too. Thank you.

I would gently add that slow is not the same as stalled. I moved twice this year, both times deliberately, both times after a conversation. That is progress with a handbrake, not no progress.

I do not think going slowly is universally better. I think it was better for me, and I am very cautious about turning my experience into anybody's rule.

Nine months at one step here and my prescriber has never once suggested moving. She said the schedule is a scaffold and I am not obliged to climb it.

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.