In general, prescription should begin at the lowest dosage. Give an adequate trial at each succeeding dosage level. Recognize that stimulants show an effect within hours, tranquilizers within days, and antidepressants sometimes not for weeks. Therapeutic blood levels for some psychotropic drugs may not be obtained routinely in clinical laboratories. Dosage for children and adolescents is more idiosyncratic than adults. Failure of one drug in a class of psychotropic drugs does not rule out using another drug in that same class. A general rule is not to use two or more drugs from the same class at once to guard against synergism. Usually dosage is increased until effective, which may sometimes be close to the level at which toxic signs appear.
Psychotropic drugs should not be discontinued quickly to minimize the occurrence of seizures or other withdrawal symptoms. “Drug holidays” should be discussed far in advance in order to assess the best opportunity for discontinuation.
Effectiveness should be judged on a weekly basis, with renewal of prescription on a monthly basis. Discontinuation of medication should be considered every three months. The responsibility of monitoring the risk-benefit ratio of long-term psychotropic drug use (for more than three months) must be shared with the guardians.