Effects of Cognitive Behavioral Therapy on Brain Serotonin Activity in People With Depression

Inclusion Criteria

• DSM-IV diagnosis of major depressive disorder (MDD)
• Drug naive from prior psychotropic medication for more than 6 months before study entry
• Hamilton-Depression (HAM-D) 17 score greater than or equal to 16
• Woman of childbearing age with a negative pregnancy test within 48 hours of scanning

Exclusion Criteria

• DSM-IV Axis I diagnosis other than MDD
• Use of psychotropic medication within 6 months of study entry
• History of bipolar disorder
• Current alcohol or drug abuse/dependence within 6 months of study entry
• History of sensitivity or intolerance to s-citalopram
• Medical contraindication to the use of s-citalopram
• Unstable medical condition (e.g., angina pectoris, untreated hypertension)
• Pregnant or nursing
• Woman of childbearing potential not using a medically acceptable form of birth control
• Actively suicidal or requiring hospitalization
• Requiring additional psychotropic drug therapy
• History of transient ischemic attacks
• History of cerebral infarction (including lacunar infarct with symptoms more than 24 hours in duration)
• History of Binswanger's disease or a history of hypertensive encephalopathy
• History of intracranial hemorrhage
• History of head trauma with loss of consciousness
• History of encephalitis
• History of extended exposure to known neurotoxin (e.g., cyanide, carbon monoxide)
• Uncontrolled metabolic disorder (e.g., thyroid disease, diabetes mellitus)
• History of cognitive impairment other than major depressive episode
• History of normal pressure hydrocephalus
• History of cancer metastatic to the central nervous system
• History of Parkinson's or other basal ganglia disease
• History of Guillain-Barré syndrome (chronic or relapsing polyneuropathy)
• Inability to undergo an MRI scan