More Is Not Always Better
When people hear that a medication is helping, the next thought is sometimes:
Should we increase it more?
Not necessarily.
One of the concepts I think is most important in psychiatric prescribing is the minimum effective dose.
What does that mean?
The minimum effective dose is the lowest dose that gives meaningful benefit without creating unnecessary side effects.
If 20 mg is working well, there may be no reason to push to 40 mg just because 40 mg is also considered a “normal” dose.
The goal is not to reach the highest dose.
The goal is to reach the right dose for you.
Higher doses can mean more side effects
Sometimes increasing a medication improves symptoms.
Sometimes it does not add much benefit, but does add:
fatigue
nausea
sexual side effects
emotional blunting
restlessness
appetite or weight changes
sleep problems
That is why I do not automatically increase something just because we technically can.
Effective does not have to mean perfect
There is also a difference between a medication helping and a medication fixing every single symptom.
Sometimes the best balance is a dose that helps significantly, is easy to tolerate, and allows other parts of treatment to do their job too.
More is not always better.
Sometimes more is just more.
The bottom line
Psychiatric medication dosing is not about chasing the biggest number on the bottle.
It is about finding the lowest dose that gives you meaningful improvement and still feels sustainable.
That is the sweet spot.
