My doctor says stay on 1mg but I feel like I need more

KevinCompounds said:

Four weeks is the pharmacokinetics, not caution.

I disagree that the ladder is purely tolerability. The maintenance and regain data cluster at the top doses, so a ladder abandoned halfway leaves you outside the evidence base for the part that matters most — keeping it off.

JenPlateau said:

Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a…

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum. But my actual experience? Slightly more appetite suppression, zero additional side effects.

Remember that the people posting about terrible side effects are a biased sample. Most people titrate up without drama — they just don't post about it because it's uneventful.

Dr.GastroMayo said:

I disagree that the ladder is purely tolerability.

Adding the part of the answer the thread has not reached. Take it one variable at a time. Almost every unanswerable question in these threads is unanswerable because three things changed in the same fortnight, and no amount of subsequent argument can untangle them after the fact.

One thing that is still open after sarah_TO’s answer:

Why the interval is four weeks rather than two, and whether a slower ladder gets to the same place?

OP back with an update, since a thread like this is useless without one.

Closing this out: I held the step for six weeks rather than four and it settled without a dose change. The interval was the answer, not the dose.