The purpose of this study is to determine the effectiveness of the antidepressant sertraline (Zoloft) in treating people with vascular depression. A second goal is to determine how well a Magnetic Resonance Imaging (MRI) scan and tests of concentration, thought, and memory can predict response to antidepressant medications. This study will also test the effects of frontal lobe dysfunction on treatment response.

Major late life depression (LLD) is an important health problem with a large and growing number of affected individuals. A significant subset of patients with LLD, particularly those with vascular depression, have abnormalities in certain parts of the brain that are evident on MRI scans and may be associated with poor acute and long-term response to antidepressant treatment. Studies have also indicated that LLD patients frequently have frontal lobe dysfunction. A longitudinal study with the antidepressant nortriptyline has demonstrated that frontal lobe dysfunction is associated with poor acute response and a greater risk for recurrence of LLD. However, it is not known if this finding applies to other antidepressants. This study will be the first clinical trial to simultaneously test the effects of specific brain and psychological factors on course of response, remission rate, and other measures of health outcomes in people with LLD.

Participants are treated with sertraline for 12 weeks. During this period, participants undergo cognitive testing, MRI, electrocardiogram (EKG), and laboratory tests. Study visits occur every 2 weeks.

Ages Eligible for Study:  60 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

• Diagnosis of unipolar major depressive disorder based on a clinical interview by a psychiatrist and a SCID interview
• English speaking
• Able to follow study procedures