When to hold and when to move — how do you decide with your clinician

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.

I asked my prescriber directly what the cost of going slowly was and she said, in effect, time. That was a trade I was happy to make once it was stated plainly.

I found I needed about three weeks at each step before I knew what that step was like. Two weeks always gave me a half-formed impression that I then acted on.

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.

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.

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.

Reading Brammy, I recognised more of that than I expected to.

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.

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 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.

Slow titration is not the cautious version of this. For some of us it is simply the version that works, and I have stopped framing it as a hedge.

I have watched people here move at four times my pace and do beautifully, and others move at half my pace and do beautifully. There is no schedule that is correct in the abstract.