Dr. Eskapa, I am about a month in (on 25mg) and am still having awful side effects. I started on 12.5mg and increased the dose after a week. How can I increase to the recommended 50mg dose if I am still sick on 25mg? Can I get a sufficient benefit from the 25mg? I'm discouraged but I don't want to quit. I just don't know if I can do this for much longer. Thanks for your advice.

Mack -- So sorry you are suffering. This is a medical question, and Dr. Eskapa will not answer it. Both he and Dr. Sinclair would refer you to your physician. They are PhDs -- not MDs. They will not give medical advice. Neither will the members here, although they share their own experience of what worked for them.

You may want to search the site for "side effects" to see how others here have handled them.

Mack3,

Your post is proof positive that everyone is different. My advice is to back off untill the side effects are tolerable; 12.5mg is better than nothing, and if that does not work, try 6.25mg. TSM is a long process, so the exact starting date is largely irrelevant. Side effects diminish over time, and it may just take longer for you. Hang in there, and ramp up slowly. It is really important that you do not become discouraged.

I wish you the very best. Please continue to post.

-wort