Aging Brain Changes, Executive Dysfunction and Depression

Inclusion Criteria

• Age: Two strata: 60-74 years (n=60) subjects and 75-84 years (n=60).
• Diagnosis: Major depression, unipolar (by DSM-IV criteria); or, for control subjects, no diagnosis of major depression, no history of depression or other psychiatric conditions.
• Severity of depression: A 24-Item HDRS above 19; Level of Executive Dysfunction: Two strata within each age stratum: Stroop Color-Word scores below and above 24 (1 SD below the median of our normal elderly sample).

Exclusion Criteria

• Psychotic depression by DSM-IV, i.e., presence of delusions with a score higher than 2 (questionable delusion) rated by the Scale for Assessment of Positive Symptoms (SAPS; 51).
• High suicide risk, i.e. intent or plan to attempt suicide in near future.
• Presence of any Axis I psychiatric disorder or substance abuse other than unipolar major depression.
• Axis II diagnosis of antisocial personality (by SCID-P and DSM-IV).
• History of psychiatric disorders other than unipolar major depression or generalized anxiety disorder (bipolar disorder, hypomania, are exclusion criteria).
• Cognition: MMSE scores below 24 or diagnosis of dementia by DSM-IV.
• 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 drugs known to cause depression, e.g., reserpine, alpha-methyl-dopa, steroids.
• Failure to respond to an adequate trial of escitalopram (10 mg/day or more for 6 weeks or longer) during the current or previous depressive episodes.
• Current involvement in psychotherapy.
• History of hypersensitivity to escitalopram or need to receive drugs that may interact with escitalopram.
• Inability to perform any of the ADLs (MAI: ADL subscale) even with assistance, e.g. walking with a cane is not an exclusion criterion.
• Inability to speak English.
• Aphasia.
• Residence outside a 45-minute drive from Cornell's clinical facilities.
• Patients taking MAOI's and Fluoxetine will be excluded.