If someone has been off medication for years, how does the doctor determine the dosing? Does the low doses of antipsychotics work? Does a higher dose usually equal better treatment of symptoms? My spouse isn’t honest about his symptoms and I think the doctor is not prescribing the medication appropriately. Any advice on how to handle this? Also, should I ask for the doctor to prescribe clozapine?
Higher dose does not always equal better treatment. It can, but dosages always vary person to person. I think the first thing you have to do is get your spouse to be honest with his symptoms or try to get into appointments with him so you can tell the psychiatrist what’s going on.
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My impression from years of experience with various psychiatrists is over the years is they get to the point they operate more on gut instinct from experience they have accumulated. There are also tables of equivalent dosages of different AP medications. I’ve asked a few here and there why they gave me one dosage or another or why they recommended one drug or another, and most of the time they couldn’t or wouldn’t say exactly. Many expert occupations are that way. Experts often can’t say exactly why they do or recommend certain things, or their explanation is developed or fleshed out after they make it.
I like to say psychiatrists are like golfers, they read the hole (patient) pick a club (drug) and decide how hard to hit it (dosage) and adjust their game from there. Here and there they sometimes break or bend their own rules, and are willing to listen to advice or consider adding new clubs and techniques, but generally they play their own style of game.
Edit: they also take what patients and caregivers say with a grain of salt, there’s a lot of reading people’s body language, posture, tone of voice etc that goes into diagnosis, prescribing medications and adjusting dosages. A bit like poker in some ways as well.
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I’ll tell you now I AM NOT A DOCTOR and I AM NOT A PHARMACIST.
It may sound silly but I look at it like this:
Is it the…
-Right person?
(you’d be surprised what over-worked, good, positive-intending practitioners might mixup. They are people too. And documentation is not always as clear or organized as we’d all hope it to be and not necessarily their fault)
-Right (prescribed) Medication?
-Right Dose? (as directed)
-Right Time? (once a day? Bi-Daily? Three times a Day?)
-Right Route? (oral, topical, injection etc.)
To your question, in my opinion.
I believe that you have no gauge to determine effects of medications on anybody if THIS is not followed. It allows us to see ‘changes’ that may (or may not) be associated with a med.
I feel the need to emphasize that EVERY PERSON IS AN INDIVIDUAL CASE AND WILL RESPOND DIFFERENTLY.
I am an advocate of taking the proper steps and taking the time by our trusted professionals to determine this.
I am also an advocate of not over-medicating.
It is, unfortunately, in my opinion, our jobs as loved ones to be the most alert, self-informed, unbiased observers of change that might indicate this. And then speak up!
However, be very careful, that we do not impose our own desires and unrealistic fantasies of what we ‘want’ or ‘remember’ our loved ones to be thinking it will all come back to what we once knew.
It will likely not.
But there are great new types of relationships we can have with them, moving on from here, in the future. Hopefully. If all goes well…
Catatonia is a specific form of this disease. Not to be confused (with over medication)
Medication adjustments can also take some time. Remember this.
Sometimes, some people just need quiet away from others and to rest, even our loved ones. From us.
As always, Lirik and MB, spot on!
Not knocking psychiatrists!
Smile… thank you for putting that in there! It’s absolutely crucial we have people with us out here in the no mans’ land to walk us through…!
There are other types of help besides medications that have proven extremely helpful not just for our loved ones (if you can get em there) but also for ourselves. I’ve personally benefitted from CBT (actively, intentionally finding a way around my own negative thinking) and remembering sometimes, just sometimes, my own health comes first! 
@Wisdom @Maggotbrane the suggestion of CBT is great. I remember reading a old post by Maggotbrane that stated you went to therapy for a while before you agreed to take medicine. I’m hoping for the same result. Thank you for your input and advice.