The Carlat Psychiatry Podcast How to Start a Psych Medication IV
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Sep 8, 2025 This discussion highlights the quick vs. slow titration methods of ziprasidone and quetiapine, stressing the importance of personalized dosing. There's an intriguing analysis of quetiapine's extended-release versus instant-release forms, with a focus on managing fatigue during treatment. The mystery of ghost pills adds depth to the conversation, while a clinical trial on pramipexole for resistant depression unveils its potential benefits and safety. The episode serves as a guide for tailored medication strategies in mental health care.
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Rapid Titration For Ziprasidone
- Titrate ziprasidone rapidly and reach the full dose within about three days for better tolerability.
- Start 40 mg twice daily with a full meal and increase to 120–160 mg by day three.
Titrate Quetiapine Slowly When Using IR
- Follow the PDR titration schedule for immediate-release quetiapine to reduce sedation and orthostatic effects.
- Use slower titration for IR formulations and consider XR for smoother peaks during dose increases.
Use XR For Older Or High-Dose Quetiapine
- Prefer quetiapine XR for older, frail, or fall-prone patients and when targeting high doses.
- Use XR to lower hypotension and fall risk, especially above 300 mg nightly.