Titrating on tolerability rather than on the calendar — the long version

Titrating on tolerability rather than on the calendar — the long version Writing it up because I had to work it out twice and would rather nobody else did.

Reporting something rather than asking about it, in case the pattern is useful to anyone else.

Over 23 weeks I logged this consistently: date, dose, time of day, and a simple severity score from 0 to 4 for each symptom. That is 157 data points, all self-reported, all unblinded, and collected by someone who knew what he expected to find. Treat it accordingly.

The reason I am posting is that my experience does not match the shape people usually describe here, and I would like to know whether that is unusual or whether the usual description is just the loudest version.

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

The four-week escalation interval is a convention from the pivotal trials, not a pharmacological constant. The pharmacological argument is that with a week-long half-life, four weeks approaches steady state and you can assess the dose fairly. That is an argument for not going faster. It is not an argument against going slower.