Imaging Predictors of Treatment Response in Depression

Exclusion Criteria

• •Acceptable method of birth control (oral contraceptives, Depo-Provera, Norplant, condoms with spermicide. A vasectomy is acceptable in the framework of a stable monogamous relationship. Sexually inactive women must agree to contraception if they become sexually active during the study.
• •Educational level, degree of understanding and reliability so that participation is feasible.
• •Informed consent to participate and comply in the study.
• •Known neurological disorders or documented head injury.
• •Serious and unstable medical illnesses including diabetes, cardiovascular disease and cancer.
• •Medical conditions with known mood changes (endocrine, autoimmune disorders)
• •Co-morbid DSM-IV Axis I Diagnoses
• •1. Lifetime history of Bipolar Disorder, Schizophrenia, and other Psychotic Disorders, or Obsessive Compulsive Disorder
• •2. Alcohol abuse or dependence within the past six months, psychoactive substance abuse or dependence within the past six months.
• •3. Clinical evidence of a severe Personality Disorder that would impede participation or completion of a controlled trial.
• •ECT within the past 6 months.
• •Previous failure to achieve a much improved status on CGI-Improvement (the equivalent of \>50% symptom reduction) with a course of CBT (defined as a minimum of 8 sessions during 8 weeks of a specified manual-driven therapy by a CBT trained therapist) or escitalopram (defined as a minimum of 6 weeks with the dose of 10 mgs achieved for at least 2 weeks)
• •Use of concomitant medications with the exception of:
• •1. Maintenance/prophylactic meds for stable medical conditions
• •2. Ambien 5-10 mgs may be prescribed for occasional use (up to a single dose a week for insomnia, as long as it is not the night before a clinic visit, PET/fMRI study or ratings.
• •3. Antidepressants will be discontinued for 7 days prior to the screening visit, which will be a minimum of a week before the baseline scan (5 weeks for fluoxetine, protryptyline).
• •Current treatment with weekly individual or group psychotherapy targeted at the depressive symptoms, including psychodynamic, interpersonal or cognitive-behavioral.
• •Currently responding to medication treatment, without clinical reasons to change (e.g. side effects). Will not enroll a subject who wishes to discontinue an effective treatment for the sake of participation in the research.
• •Woman who are pregnant, breast feeding or intending to become pregnant during the course of the study.
• •Contraindications for MRI: pacemaker, aneurysm clips, neurostimulators, cochlear implants, metal in eyes, steel worker, or other implants.