Emotional and Cognitive Control in Late-Onset Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Intervention: Escitalopram; Magnetic Resonance Imaging
Intervention description: 20 mg target dose for 12 weeks; Structural and functional MRI of the brain for research purposes.
Intervention MeSH terms: Escitalopram
Phase: Phase 4
Study type: Interventional
Primary purpose: Basic Science
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 121.0
Sex: All
Minimum age: 60 Years
Maximum age: 85 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Depression; Depressive Disorder; Behavioral Symptoms; Mood Disorders; Mental Disorders; Escitalopram; Central Nervous System Agents; Therapeutic Uses; Pharmacologic Actions; Physiological Effects of Drugs; Muscarinic Antagonists; Antidepressive Agents; Psychotropic Drugs; Serotonin Uptake Inhibitors; Neurotransmitter Uptake Inhibitors; Serotonin Agents; Magnetic Resonance Imaging, Functional; fMRI; Magnetic Resonance Imaging

Summary:

      This study may help identify how abnormalities in brain systems that control the ability to
      ignore irrelevant information may contribute to the development of depression in older
      adults.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Age: 60-85 years, right-handed;

          -  Diagnosis: Major depression, unipolar (by Structured Clinical Interview for Diagnostic
             and Statistical Manual (DSM)IV (SCID-R) and DSM-IV criteria);

          -  Age of onset of first episode ≥ 50 years with up to three depressive episodes;

          -  Severity of depression: A 24-Item Hamilton Depression Rating Scale (HDRS) ≥ 20.

        Exclusion Criteria:

          -  Psychotic depression by DSM-IV, i.e., presence of delusions with a SCID-R score higher
             than 2;

          -  High suicide risk, i.e. intent or plan to attempt suicide in near future;

          -  Presence of any Axis I psychiatric disorder (other than unipolar major depression) or
             substance abuse;

          -  History of psychiatric disorders other than unipolar major depression or generalized
             anxiety disorder (bipolar disorder, hypomania, and dysthymia are exclusion criteria);

          -  Dementia: Diagnosis of dementia by DSM-IV;

          -  Mild Cognitive Impairment (MCI);

          -  Acute or severe medical illness, i.e., delirium, metastatic cancer, decompensated
             cardiac, liver or kidney failure, major surgery, stroke or myocardial infarction
             during the three months prior to entry; or use of drugs known to cause depression,
             e.g., reserpine, alpha-methyl-dopa, steroids, sympathomimetics withdrawal;

          -  Neurological brain disease and/or history of electroconvulsive therapy;

          -  History of any use of citalopram or escitalopram during the current episode or need
             for drugs that may interact with these agents, i.e. drug metabolized by the 2D6 P450
             isoenzyme system;

          -  Current involvement in psychotherapy;

          -  Contraindications to MRI scanning including cardiac pacemaker, metallic objects and
             metallic implants contraindicating MRI, cardiac stent, claustrophobia;

          -  Inability to speak English;

          -  Corrected visual acuity < 20/70; Color blindness.