This study will determine whether adding interpersonal psychotherapy to treatment with the antidepressant escitalopram will be more effective in reducing symptoms of depression than antidepressant medication alone.

The purpose of this research study is to learn if adding psychotherapy (Interpersonal Psychotherapy) to antidepressant medication (escitalopram), will be more effective in reducing lingering symptoms of depression and decreasing the burden of these symptoms, when initial treatment with just antidepressant medication alone has led to only a partial response. Participation in the study will last up to 22 weeks.

Because fewer than 50% of elderly depressed patients achieve remission and recovery in response to first-line antidepressant pharmacotherapy, the majority of patients are left with significant symptoms and functional impairment, putting them at risk of chronic, relapsing illness, non-adherence to other medical treatment, suicide, and family caregiver burden. We will recruit and treat 320 patients with unipolar major depression aged 60 and older, using clinical management with escitalopram 10 mg/day for six weeks. Patients who are partial responders to escitalopram plus clinical management will be randomly assigned to 16 weeks of extension therapy with either 20 mg escitalopram plus clinical management or 20 mg escitalopram plus Interpersonal Psychotherapy (IPT, 16 sessions). Changes over time in measures of depressive symptoms, hopelessness, suicidal ideation, disability, and family caregiving burden will be assessed. This study will answer the question of how best to treat partial responders-by simply extending pharmacotherapy at higher doses, or by also adding psychotherapy-to remission and recovery.

For information on related studies, please follow these links:

http://clinicaltrials.gov/show/NCT00178035

http://clinicaltrials.gov/show/NCT00178074

Inclusion Criteria:

• Diagnosis of unipolar major depression
• Hamilton Rating Scale for Depression (HRSD) (17 item) score of 15 or higher
• Speaks English
• Willing to discontinue other psychotropic medications
• Availability of family member or other caregiver
• Hearing capacity adequate to respond to a raised conversational voice

Exclusion Criteria:

• Lifetime diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, or any psychotic disorder
• Folstein Mini-Mental Status Exam (MMSE) of 17 or lower
• Suicidal
• History of treatment non-adherence in other Center protocols
• History of documented non-response to citalopram in other Center protocols
• History of non-tolerance to escitalopram therapy

The study design does not allow an inference about which specific intervention led to further improvement. Was it simply a dose increase of escitalopram from 10mg to 20mg? Is this intensive contact necessary for improvement?