Global Journal of Medical Research, A: Neurology & Nervous System, Volume 23 Issue 3

VII. T oward I mproving the P recision of P sychotropic D rug D osing With so many variables affecting dosing requirements, the safest and most accurate way to titrate psychotropic drugs, like most other drugs, is to start low and go slow. Another helpful practice is to consider a patient’s ethnic background, as some ethnic groups, such as Asians, tend to be slow metabolizers of some drugs [88, 89]. Still, the problem with a gradual titration is that it can delay clinical improvement by weeks or even months because antidepressants, which in psychiatry are the most commonly prescribed drugs, take several weeks to exert their therapeutic effects. This is in-part what drove the development of the new pharmacogenomic tests. It was thought that by coordinating drug selection to a patient’s enzyme activity, antidepressant therapy could be initiated at doses closer to the therapeutic dose without significantly increasing the risk of medication side effects. However, as previously discussed, the many other factors that influence dosing requirements besides metabolism can cause the genomic testing results to be misleading. Therefore, it is also important to review the patient’s experience with other medications that may have been tried, particularly those in the same class as the proposed medications. This can be very helpful because an individual’s sensitivity to medication tends to generalize across drug classes and across medications within a given class. Yet another dosage guide, and one that is seldom utilized, is the history of drug sensitivities in the patient’s parents, siblings, and other blood relatives. If high drug sensitivity is found to run in a patient’s family, the clinician should allow the patient to fractionate the lowest available dosage of any newly-prescribed medication. If the starting dose is found to be well-tolerated, the patient can simply take a little more of the medication. An added benefit of this conservative approach is that the unlikelihood of side effects gives the patient a little more time to overcome any apprehension about starting a new psychotropic drug. It is far better for a patient to become impatient with a new drug than to become frightened of it due to initial side effects. These simple precautionary measures can, in some cases, make the difference between a successful outcome with a drug and an outcome that leaves the patient unwilling to take any more of the drug or, worse yet, any other psychotropic drug. Another cautionary note with regard to drug dosing is the use of serum levels. Although obtaining a blood level can be helpful in some cases, blood levels should not be used as a substitute for close clinical monitoring during dosage titration. That’s because blood levels do not take into account the possibility that a particular patient may be highly responsive to a drug, thus allowing lower-than-average blood levels to achieve an adequate therapeutic effect. In many cases, these lower blood levels can prevent the occurrence of side effects without compromising effectiveness because most drugs exert their optimal therapeutic effects at a dosage just below their side effect dosage. Where blood levels are most useful is in the monitoring of patients who, for the various reasons described earlier, require unusually high doses of a particular medication in order to achieve a therapeutic effect. In such cases, obtaining a blood level can be used to justify the need for higher dosing and can also be used to substantiate any suspicions of medication non-compliance or drug diversion. Unfortunately, far too many patients are allowed to bear unnecessary side effects simply because the prescriber felt the need to maintain the serum level within the “therapeutic range.” VIII. D iscussion The goal of this article was to address the problems of diagnostic confusion, psychotropic drug overprescribing, and side-effect burden due to a lack of precision in the treatment of psychiatric disorders. All of these problems could potentially be minimized by applying an emerging hypothesis that contends that psychiatric symptoms are the consequence of cognitive- emotional stress superimposed upon a pathological hyperexcitability of the neurological system. Fortuitously, targeting this problem with neuroregulators yields rapid results, thus allowing the medications to be started at comfortably low doses and rapidly titrated to clinical improvement. In so-doing, the risk of side effects is minimized without substantially extending the time to therapeutic effect. Also, by remaining focused on the biological target, focused neuroregulation streamlines treatment, thus circumventing the need to use combinations of drugs that, being directed at symptoms rather than neuropathology, may have competing or even paradoxical effects. Anecdotally, focused neuroregulation has yielded far more improvement, in far less time, and with far less side effects than standard antidepressant therapy in a wide range of psychiatric disorders, including the majority of patients who would, based on current nosology, be diagnosed with major depressive disorder or dysthymia. Moreover, in nearly all of these patients, some of whom have been observed for more than two decades, the initial benefits have been maintained without any need of further dosage adjustment. Although anticonvulsant neuroregulators are also used to treat epilepsy, the dosage of these drugs can usually be lower when treating psychiatric disorders because the target abnormality, namely neuronal hyperexcitability, is entirely reversible. This is in contrast to seizure disorders, in which the excitability of the neurological system might need to be brought to subnormal levels in order to compensate for the structural abnormality that may be lowering the seizure 30 Year 2023 Global Journal of Medical Research Volume XXIII Issue III Version I ( D ) A © 2023 Global Journals A Precision Medicine Approach to the Treatment of Psychiatric Disorders