**3.2 Dosing considerations**

Since veterans with PTSD often present with marked anxiety, they may be very sensitive to the potential heightened anxiety sometimes seen early in treatment with antidepressants. Patients benefit from a "start low, go slow" approach to medication titration, such as starting at ¼ to ½ the usual starting dose and then gradually increasing to a therapeutic level (Cooper et al., 2005, American Psychiatric Association, 1998). While the initiation of medication might be slow and cautious, ultimately the dose should be titrated to full symptom remission at maximum tolerated doses.
