Predictors of Antidepressant Response
Condition: Depression
MeSH terms: Depression
Intervention: Placebo, identified as placebo to participants; Celexa or other antidepressant as clinically indicated; Placebo, identifed to participants as "Active medication"
Intervention description: White tablets; Open label s-citalopram, 20 mg start up dose, increasing to 40 mg as clinically indicated; If prior non-response to this medication is noted by the patient, alternative treatments may include another first-line antidepressant:fluoxetine 20 mg; paroxetine up to 60 mg; sertraline up to 200 mg; bupropion up to 300 mg; Blue Capsule
Intervention MeSH terms: Antidepressive Agents; Citalopram
Phase: Phase 4
Study type: Interventional
Primary purpose: Other
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Enrollment: 44.0
Sex: All
Minimum age: 18 Years
Maximum age: 60 Years
Healthy volunteers: No

Summary:

      Major depression is a highly prevalent, frequently debilitating illness that too often fails
      to respond to currently available treatments such as antidepressant medication. Furthermore,
      randomized controlled trials of antidepressants consistently demonstrate large placebo
      effects. The investigators hypothesize that individual differences in the function of key
      brain circuits underlie the observed variability in clinical responses to both placebo and
      antidepressant medication. This study will test this hypothesis by recruiting
      treatment-seeking volunteers with major depression, with or without comorbid nicotine
      dependence. Volunteers will participate in positron emission tomography (PET) and functional
      magnetic resonance imaging (fMRI) scans in the context of a treatment trial in which they
      will receive both placebo and antidepressant medication. A major goal of the study is to
      improve prediction of individual clinical responses in future treatment trials in which brain
      imaging may be unavailable, and to study the mechanisms of antidepressant response in Major
      Depression.
    

Eligibility criteria:

        Inclusion Criteria: Inclusion criteria will include:

          -  Participants diagnosed with Major Depressive Disorder and will include Hamilton
             Depressive Rating Scale (HDRS) scores >15

        Exclusion Criteria:

          -  Comorbid conditions that are medical, neurological or psychiatric, pregnancy, use of
             hormones (including birth control) or use of psychotropic agents

          -  We will only permit certain past anxiety disorder diagnoses, including generalized
             anxiety, panic, agoraphobia, social phobia

          -  We also will exclude left-handed individuals and patients who have used any centrally
             acting medications or recreational drugs with the past 2 months

          -  No history of an implant, pacemaker or pacemaker wires, open heart surgery, artificial
             heart valve, brain aneurysm surgery, middle ear implant, hearing aid, braces or
             extensive dental work, cataract surgery or lens implant, implanted mechanical or
             electrical device, or artificial limb or joint

          -  No metallic object in their body (such as braces) or have a history of foreign
             metallic object in the body such as bullets, BB's, pellets, shrapnel, or other metal
             fragments