INCLUSION CRITERIA:
CRITERIA FOR INCLUSION OF DEPRESSED PATIENTS:
-age 18-65 years
-written informed consent completed (consent-incapacitated subjects will not be eligible)
-score 20 or higher on the Montgomery-Asberg Depression Rating Scale (MADRS)
-meets DSM-IV criteria for chronic or recurrent nonpsychotic MDD
-patients who are on non-excluded concomitant medications.
-no more than 3 failed antidepressant treatments within the current major depressive episode
-no alcohol use (last 7 days)
ADDITIONAL CRITERIA FOR INCLUSION OF DEPRESSED PATIENTS FOR MRI IMAGING:
-age 18-55 years
-subjects must have either a family history of mood disorders, or have a history of
multiple major depressive episodes
-age of onset of depressive symptoms less than 45 years
-no history of past alcohol or substance dependence (excluding nicotine) or alcohol or substance abuse (excluding nicotine) within the past year.
-no use of benzodiazepines within 2 weeks of either MRI scan
CRITERIA FOR INCLUSION OF HEALTHY CONTROL SUBJECTS:
-age 18-65 years
-written informed consent completed
-no current or past diagnosis of axis I psychiatric disorder (DSM-IVTR)
-no alcohol use (last 7 days)
-physically healthy
ADDITIONAL CRITERIA FOR INCLUSION OF HEALTHY CONTROL SUBJECTS FOR MRI IMAGING:
-age 18-55 years
-no history of past alcohol or substance dependence (excluding nicotine) or alcohol or substance abuse (excluding nicotine) within the past year.
EXCLUSION CRITERIA:
CRITERIA FOR EXCLUSION OF DEPRESSED PATIENTS:
-history of bipolar disorder (I, II, or NOS) (lifetime)
-history of schizophrenia
-history of schizoaffective disorder or
-psychosis NOS (lifetime)
-history of anorexia nervosa or bulimia nervosa (lifetime)
-current primary obsessive-compulsive disorder (OCD) or current post traumatic stress disorder (PTSD)
-history of clear-cut intolerability to the study medication
-lack of response to an adequate trial of the study medication (citalopram) in the current or past episodes of MDD
-did not respond to 7 or more sessions of ECT in the current episode of MDD
-Serious, unstable illnesses including hepatic, renal, gastroenterologic, respiratory, cardiovascular (including ischemic heart disease), endocrinologic, neurologic, immunologic, or hematologic disease.
-has general medical condition which contraindicates the use of the study medication
-is on concomitant medication which contraindicates the use of the study medication
-requires immediate hospitalization for psychiatric disorder
-requires antipsychotic medications or mood stabilizers
-Non-postmenopausal (less than 2 years since last period) females of childbearing potential who are sexually active and who are not using adequate (hormonal, double barrier, surgical) contraception, or who are pregnant or breast feeding
-patients currently taking any of the exclusionary medications detailed in protocol (including antipsychotic medications, anticonvulsant medications, antidepressant medications, mood stabilizers, central nervous system stimulants) in the 2 weeks prior to Study Period II.
-patients taking thyroid medication for hypothyroidism may be included if they have been stable on the medication for greater than 3 months
-patients can participate in a modality of psychotherapy that is not targeting the symptoms of depression (e.g., supportive therapy, marital therapy)
-therapy that is depression specific, such as Cognitive Therapy (CT) or Interpersonal Psychotherapy of Depression (IPT) is not allowed during participation
-subjects must be fluent in English and have the capacity to understand the nature of the study and sign the written informed consent.
-current alcohol dependence or abuse (last 3 months)
ADDITIONAL CRITERIA FOR EXCLUSION OF DEPRESSED PATIENTS FOR MRI IMAGING:
-subjects meeting general exclusion criteria for MRI scanning (e.g. implanted cardiac pacemaker, intraocular metal) will be excluded from the MRI procedures only.
-subjects with structural lesions visible on MRI will be excluded from further MRI procedures
-subjects with diabetes or hypertension will be excluded
CRITERIA FOR EXCLUSION OF HEALTHY CONTROL SUBJECTS:
-subjects currently taking any of the exclusionary medications detailed in protocol in the 2 weeks prior to evaluation
-current alcohol dependence or abuse (last 3 months)
-history of major depression or bipolar disorder in any first degree relative
ADDITIONAL CRITERIA FOR EXCLUSION OF HEALTHY CONTROL SUBJECTS:
-subjects meeting general exclusion criteria for MRI scanning (e.g. implanted cardiac pacemaker, intraocular metal) will be excluded from the MRI procedures only.
-subjects with structural lesions visible on MRI will be excluded from further MRI procedures
-subjects with diabetes or hypertension will be excluded