Dr.NateNeph said:

The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks…

I disagree that the ladder is purely tolerability. The maintenance and regain data cluster at the top doses, so a ladder abandoned halfway leaves you outside the evidence base for the part that matters most — keeping it off.

AmyNC_wife said:

I titrated faster than the label because I felt fine, hit a wall at the third step, and had to come back down — which I now think was the predictable…

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum. But my actual experience? Slightly more appetite suppression, zero additional side effects.

Remember that the people posting about terrible side effects are a biased sample. Most people titrate up without drama — they just don't post about it because it's uneventful.

LibrarianMeg said:

I disagree that the ladder is purely tolerability.

There is a second half to this that has not been said yet. The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either. Those three things can all be true at once, and most arguments here are two people holding different parts of that.

One thing that is still open after raj_cambridge’s answer:

Why the interval is four weeks rather than two, and whether a slower ladder gets to the same place?

OP back with an update, since a thread like this is useless without one.

Closing this out: I held the step for six weeks rather than four and it settled without a dose change. The interval was the answer, not the dose.