If the patient is not yet responding, and if the maximum is not yet reached, consider increasing / optimizing the dose.
Need to consider severity of the illness when deciding to increase the dose. For patients with mild illness consider waiting longer for response to avoid unnecessary side effects.
lower doses or less frequent dosage increase may be better for very somatically preoccupied or medically compromised patients
for patients who develop treatment-emergent anxiety may need to drop the dose and go more slowly
consider allowing the anxious patient, who is worried about side effects, some control as to when he or she feels comfortable increasing the dose
for patients with obsessive-compulsive disorder it is recommended to try to increase the medication to the maximum tolerable dose and maintain that dose for at least eight weeks before considering switching or augmenting (unless augmenting with psychotherapy)
Do not increase/maximize the antidepressant dose if:
There are significant side effects (consider using FIBSER.pdf ) or drug allergies