The Carlat Psychiatry Podcast How to Start a Psych Medication VI
Sep 22, 2025
Chris Aiken and Kellie Newsome dive into the art of starting psych medications. They discuss the importance of slow titration for meds like bupropion and trazodone to minimize anxiety and side effects. Special attention is given to adjusting typical dosing for safety, particularly with valproate and antipsychotics. The duo also touches on the unique approach needed for disulfiram and shares insights from a meta-analysis on antidepressant discontinuation, making for an engaging blend of practical tips and research updates.
AI Snips
Chapters
Books
Transcript
Episode notes
Start Bupropion Low And Titrate Slowly
- Start bupropion low in anxious patients, for example 75 mg daily, then increase by 75 mg each week.
- Use the same slow titration strategy when using bupropion in bipolar disorder to reduce risk of mood switching.
Titrate Topiramate Slowly And Keep Doses Modest
- Start topiramate at 25 mg at night and increase by 25 mg weekly to reduce cognitive side effects.
- Keep total dose modest (around 100 mg) for psychiatric indications like binge eating or weight loss.
Slow Carbamazepine Titration And Response-Based Dosing
- Start carbamazepine at 100 mg daily and raise by 100 mg every 5–7 days to reduce dizziness and sedation.
- Dose carbamazepine by clinical response rather than relying on exact serum levels used in epilepsy.
