fMRI Studies of Emotional Brain Circuitry in People With Major Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This study will examine activation of a brain circuit that regulates emotion in depressed
      patients before and after treatment to see which areas of the brain are involved in chronic
      depression.
    

Detailed description: 
      Major depressive disorder can be a recurrent problem for many people, interfering with their
      ability to function normally in day-to-day life. Although research shows that activation in
      certain brain areas corresponds to certain emotional functions, it is not well known which
      specific changes in brain functioning are related to or caused by depression. A proposed
      theory holds that depression is related to abnormal regulation of emotions and thoughts. This
      study will focus particularly on a brain circuit involved in emotional regulation, which
      includes the amygdala, the affective division of the anterior cingulate (ACad), and
      dorsolateral prefrontal cortex (DLPFC). The amygdala detects critical emotional information,
      especially threats; the ACad judges relevance of motivational cues, detects conflict, and
      regulates emotional responses; and the DLPFC has a critical role in supporting a wide range
      of cognitive control functions. This study will compare brain scans from people with and
      without depression to attempt to clarify which changes in brain functioning are related to
      depression.

      Participation in this study will last 8 weeks. All participants will undergo initial
      screening in a telephone interview, then a diagnostic interview and brief physical
      examination. After passing through screening, participants will schedule a functional
      magnetic resonance imaging (fMRI) scan. The fMRI scan, lasting approximately 2 hours, will
      take pictures of both brain structure and brain functioning during different tasks. Also at
      this visit but outside the fMRI scanner, participants will be asked to complete an additional
      2 hours of tasks on a computer. Depressed participants will then be given Lexapro, an
      approved drug for the treatment of depression. Participants taking Lexapro will go to
      scheduled doctor's visits after 2, 4, and 6 weeks of treatment to assess health,
      effectiveness of the drug, and side effects. On the eighth week, all participants will again
      undergo fMRI scanning and computer testing. At both the initial and follow-up fMRI study
      visits, images of brain function and anatomy will be recorded, heart rate will be monitored,
      and anxiety and arousal will be measured in the computer tests.
    

Intervention name(s): Lexapro
Intervention type(s): Drug
Intervention description(s): 10 mg by mouth once per day for first 2 weeks, with psychiatric re-evaluation every 2 weeks to determine if any change in dosage is required, with a maximum of 20 mg per day
Other intervention name(s): Escitalopram
Intervention MeSH terms: Escitalopram
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Emotional Circuitry; fMRI