This study will determine the effectiveness of offering primary care patients their preferred treatment versus one that is less desirable in improving treatment adherence and outcome.

This study investigates whether offering primary care patients treatment that is congruent with their preferred first choice improves adherence and outcomes, in comparison to offering treatment that is not congruent with their preferred first choice. All subjects are offered a treatment with demonstrated efficacy, namely either the antidepressant medication escitalopram or Interpersonal Psychotherapy for 5 months. We hypothesize that patients who receive congruent treatment will be more likely to initiate treatment, adhere to treatment, and achieve depression remission.

Inclusion Criteria:

• age 21-99
• English-speaking
• DSM-IV criteria for major depression

Exclusion Criteria:

• unable to give informed consent
• MMSE<24
• DSM-IV diagnosis of bipolar disorder, psychotic disorder, current alcohol or substance abuse
• active suicide ideation
• aphasia
• acute or severe medical illness
• currently receiving either antidepressant medication or psychotherapy