Hi pipsqueak, I've noticed from people's posts that docs in the States tend to start with higher doses and also that many american patients are prescribed a combo of several meds. I'm not sure about all parts of Europe but around here they're usually very hesitant to medicate you for anything, especially mental illness. It seems they wish you would just go home and get better on tap water, which is ridiculous- we pay a ridiculously high amount into health care monthly and have to practically beg to be treated when treatment is needed. But that's another story altogether. I think the decision about the starting dose also depends on the patients current situation. As I understand, those who have proven sensitive to side effects in the past or are not severely depressed start with the lower dose. When the patient is already so down and exhausted that they have trouble with performing basic tasks even or struggle to concentrate they're usually put on a higher dose so as to ensure serotonin levels are quite stable from the buildup of the drug when they start cognitive or other therapy. They want you to be able to think, focus and perform daily tasks and take responsibility as soon as possible and once you seem to function and do quite well in therapy they lower the dose to twenty mg. I'm also told the dosage for depression is usually lower than when there are some other severe disorders present.