Antidepressant up-titration: pharmacological and psychological considerations

The use of antidepressant up-titration in starting therapies is useful in reducing side effects, but can induce delays in clinical response. Several aspects concerning slow or more aggressive titration have to be considered when using this strategy, such as pharmacological aspects (e.g., synaptic up-regulation) and psychological/clinical aspects (e.g., adherence to antidepressant treatment, and the temperament and expectations of patients). Data from the literature are controversial, and so the choice between rapid and slow titration must be tailored more to the patient, rather than to the drug.