Please select the eligibility criteria that correspond to the clinical trial below.
Title: Duloxetine for Chronic Depression: a Double-blind Study
Brief Summary: The investigators are studying a new antidepressant medicine, duloxetine, for the treatment of people with chronic depression. Duloxetine (trade name Cymbalta) was recently approved by the FDA for the treatment of major depression. The investigators are testing whether this medicine is also effective for adults with chronic depression (dysthymic disorder or dysthymia).

Chronic depression, lasting two or more years, often causes significant suffering and impairment. The investigators study involves a 6 to 10 week double-blind Initial Phase during which half of the participants will take the new medication and half will take a placebo (an inactive look-alike pill). After the Initial Phase, a 12-week Continuation Phase will begin, during which all subjects can be treated with an FDA-approved antidepressant medication.

Eligible subjects may also receive MRI scans, to help the investigators understand how antidepressants work in treating depression.


Options:
A: Inclusion Criteria:

* Recurrent unipolar major depressive disorder
* Have experienced at least two episodes of major depression
* Have experienced at least one period of recovery during a depressive episode or have a history of dysthymia (a mood disorder characterized by depression) prior to the onset of current or past depressive episodes
* Willing and able to comply with all study requirements
* Able to speak and read English

Exclusion Criteria:

* Active alcohol or other substance dependence within 6 months prior to study entry
* Currently at risk for suicide
* Mood disorders due to a medical condition or substance abuse
* Bipolar, schizoaffective, obsessive compulsive, or eating disorders
* Schizophrenia
* Unable to stop mood-altering medications
* Current use of medication or diagnosis of a medical disorder that may cause depression (e.g., diabetes, head injury, stroke, cancer, multiple sclerosis)
* Previous failure to experience a reduction in depressive symptoms after 8 weeks of cognitive therapy with a certified therapist
* Previous failure to experience a reduction in depressive symptoms after 6 weeks of 40 mg of Prozac
* Pregnancy or plan to become pregnant in the next 11-12 months
* Unable to attend clinic twice weekly during business hours
* Unable to complete questionnaires
B: Inclusion Criteria

* Clinical diagnosis for recurrent major depression

Exclusion Criteria

* The patient has failed on an adequate trial of fluoxetine, venlafaxine or venlafaxine ER during the current episode of major depression or the patient is treatment-resistant
* Known hypersensitivity to venlafaxine or fluoxetine
* History or presence of clinically significant hepatic, cardiovascular or renal disease, or other serious medical disease, including history of seizure disorder
C: Inclusion Criteria:

* age 20 to 75 years (ages 20 to 60 for MRI sub-study)
* diagnosis of dysthymic disorder (chronic depression) or depression NOS
* minimum of 2 years duration of current episode of depression

Exclusion Criteria:

* current major depression
* diagnoses including delirium, dementia, bipolar disorder, schizophrenia
* substance abuse or dependence in the past 6 months
* pregnant or nursing women
* serious risk of suicide
D: Inclusion Criteria:

* adults aged 20-75 years
* a primary diagnosis of Dysthymic Disorder, Chronic major depressive disorder or double depression
* a \>50% decrease in 17 item Hamilton Rating Scale for Depression (HRSD-17) score and a final HRSD-17 score ≤ 10 with an adequate antidepressant medication (ADM) trial (\> 4 weeks on at least 50% Physician's Desk Reference maximum ADM dose)
* a rating of 1 ("very much improved") or 2 ("much improved") on the Clinical Global Impressions-Improvement scale (CGI-I)
* continued functional impairment, defined by scores \>1.9 on the Social Adjustment Scale (SAS)
* unemployment (jobless, looking for work) according to the Bureau of Labor Statistics: jobless and looking and available for work, or underemployed.

Exclusion Criteria:

* Structured Clinical Interview for Diagnostic and Statistical Manual, fourth edition (DSM-IV) Axis I disorders-diagnosed cognitive or psychotic disorders
* bipolar disorder
* active eating disorders
* severe borderline personality disorder
* alcohol or drug dependence (except nicotine) in the last 6 months
* current suicide risk
* unstable medical conditions
* use of psychotropic medications other than antidepressants

Answer: C